THE  LIBRARY 

OF 

THE  UNIVERSITY 
OF  CALIFORNIA 


PRESENTED  BY 

PROF.  CHARLES  A.  KOFOID  AND 
MRS.  PRUDENCE  W.  KOFOID 


W  O  E  M  S. 


juries  of 


PRACTICAL    HELMINTHOLOGT. 


Beorge  H,  ffinterlnrS 

WORMS. 

£  Sam  el  f  tOm 

ON 

PEACTICAL    HELMINTHOLOGY 

DELIVERED  AT  THE 

MEDICAL  COLLEGE  OF  THE  MIDDLESEX  HOSPITAL ; 

With  Gases  Illustrating  the  Symptoms,  Diagnosis,  and 
Treatment  of  Internal  Parasitic  Diseases. 


BY 

T.  SPENCER  COBBOLD,  M.D.,  F.R.S. 

HONORARY  COHHBSPONDENT  OF  THE   ACA.DEMY  OF  SCIBKCES 
OF  P1IILADELPHIA. 


PHILADELPHIA : 
LINDSAY    AND     BLAKISTON. 

1872. 


PREFACE. 


IN  these  Lectures  I  have  not  attempted  to  cover 
the  whole  ground  of  Practical  Helminthology ; 
nevertheless,  with  the  exception  of  hydatids,  I  have 
more  or  less  fully  considered  all  those  forms  of 
internal  parasitism  which  ordinarily  come  under  the 
notice  of  the  physician. 

The  first  six  of  these  discourses  have  appeared 
in  the  pages  of  the  Medical  Times  and  Gazette; 
the  remainder  are  entirely  new,  and  have  been 
only  very  recently  delivered. 

To  any  rightly  constituted  mind  the  process  of 
self-assertion  is  always  a  painful  operation;  yet 
there  are  circumstances  which  not  merely  justify, 
but  actually  necessitate  such  a  step  in  the  interests 
of  truth. 

As  I  have  remarked  at  the  close  of  the  chapter 
on  Trichina  spiralis,  in  the  supplement  to  my  larger 
treatise,  there  are  authors  "  on  this  side  the  Channel 
who  systematically  ignore  the  labours  of  their  own 
countrymen."  Acting  for  myself,  therefore,  I  can 
only  meet  such  puerile  negations  of  home-work 
by  pointing  to  the  several  papers  I  have  contri- 


M35Q775 


VI  PREFACE. 

buted  to  this  department  of  Medical  Science  and 
Biology.  The  titles  of  these  fragments  and  more 
sustained  efforts  I  have  thrown  together  in  an 
Appendix,  and  in  this  shape  they  will  at  least  have 
the  advantage  of  expressing  the  sum  of  my  felt 
indebtedness  to  editors  and  to  other  learned  and 
liberal-minded  persons  who,  throughout  a  period  of 
nearly  twenty  years,  have  generously  and  persistently 
encouraged  me  in  these  researches. 

As  it  is  now  too  late  for  me  to  allude  to  the 
subject  elsewhere  in  these  pages,  I  wish  particularly 
to  call  attention  to  the  very  recently  issued  "  Seventh 
Annual  Report  of  the  Sanitary  Commissioner  with 
the  Government  of  India." 

From,  Dr.  Cunningham's  Report  it  appears  that 
Dr.  Oliver,  of  the  Royal  Artillery,  at  Jullunder,  has 
succeeded  in  experimentally  rearing  the  Tania 
mediocanellata  in  a  low  class  Mahommedan  syce  and 
in  a  Hindoo  boy,  by  the  ingestion  on  their  part  of 
beef-measles;  thus  affording  most  interesting  con- 
firmation of  the  truth  of  certain  practical  conclu- 
sions which  I  have  enforced  on  other  grounds  in  my 
Cantor  Lectures  and  in  the  earlier  pages  of  the 
present  treatise. 

T.  S.  C. 

84,  WIMPOLE  STREET,  CAVENDISH  SQUARE, 
Jan.  5th,  1872. 


CONTENTS. 


LECTURE  I. 

Parasitism  offers  a  new  Field  of  Research — Life,  History,  and  Eco- 
nomy of  the  Entozoa — Teleological  Inferences — Serious  Maladies 
produced  by  Helminths — Demand  for  a  Special  Recognition  of 
this  Class  of  Diseases — General  Structure  of  the  Tapeworms — 
Diagnostic  and  Prognostic  Value  of  a  Knowledge  of  the  Major 
Facts  of  Development — Case  I. — Tapeworms  are  derived  from 
Mutton,  Beef,  and  Pork pp.  1—6 

LECTURE  II. 

Necessity  of  distinguishing  the  various  kinds  of  Tapeworm — Means 
of  Identification — Diseases  often  produced  by  the  Larvae  of  Para- 
sites —  Cerebral  Symptoms  from  Cysticerci — Natural  Cures 
effected  by  Calcareous  Degeneration  of  the  Larvae  —Duration  of 
the  Life-epoch  of  the  Beef-measle — Hydatids  apt  to  be  con- 
founded with  Cysticerci — Degree  and  Variety  of  Symptoms  pro- 
duced by  Tapeworm — The  worst  Symptoms  may  remain  after  a 
Cure  has  been  effected — Case  II pp.  7 — 13 

LECTURE  III. 

Nervous  Symptoms  erroneously  ascribed  to  Tapeworm — Case  III. — 
Necessity  of  being  free  from  Doubt  as  to  the  Presence  or  Absence 
of  Parasites — The  Patient's  Mind  must  be  fully  informed  and 
satisfied — Cases  IV.  to  VIII.  serve  to  illustrate  this  Point — 
Supreme  Importance  of  a  Correct  Diagnosis — Parasitic  Diseases 
frequently  overlooked — The  Proper  Remedies  for  Tapeworm — 
Anthelmintics  to  be  employed  with  Discrimination — Prevalence 
of  the  Beef  Tapeworm pp.  14 — 19 


Vlll  CONTENTS. 


LECTURE  IV. 

Illustrations  of  the  Relative  Value  of  Particular  Drugs— Cases  IX. 
and  X. — Uselessness  of  Santonin  in  Tapeworm— Impropriety  of 
giving  Remedies  which  exert  no  Poisonous  Action  on  the  Para- 
site— Reasons  for  discountenancing  the  Employment  of  the  Oil 
of  Turpentine — Caae  XI.  affords  an  Instance  of  the  Anthelmintic 
Activity  of  Turpentine,  the  Head  being  dislodged  under  circum- 
stances of  peculiar  Interest — No  Necessity  for  long  Fasting 
before  taking  Vermifuges — Relative  Merits  of  Kousso  and  Male- 
fern —  Case  XII.,  in  which  the  Head  of  the  Worm  was 
Found pp.  20—26 


LECTURE  V. 

Caution  to  be  observed  before  definitely  pronouncing  a  Cure — 
Case  XIII.,  where  Two  Worms  existed  and  One  Head  only 
came  away — Always  Search  for  the  Head  of  the  Worm  if 
possible — Caae  XIV.  gives  a  Cure  in  which  the  Vision  was 
affected,  the  Head  of  the  Worm  not  having  been  sought  for — 
Cases  XV.  to  XIX.  afford  Instances  of  Cures  where  the  Head 
of  the  Worm  was  either  not  discovered  or  not  sufficiently 
searched  for — A  Trichocephalus  dislodged  by  the  Action  of  Male- 
fern  pp.  27—33 


LECTURE  VI. 

Four  Successful  Cases  (XX.  to  XXIII.)  in  which  the  Head  of  the 
Tapeworm  was  expelled  and  found — Possibility  of  dislodging  and 
finding  the  Head  when  nothing  else  is  left  to  operate  on — 
The  Head  of  a  Bird's  Tapeworm  obtained  under  still  greater 
Difficulties — Supposed  Case  (XXIV.)  of  the  Broad  Tapeworm 
or  Bothriocephalus  latus—Ca&e  XXV.,  illustrating  the  apparent 
Superiority  of  Male-fern  over  Areca  Nut  in  the  Treatment  of 
Tapeworm pp.  34 — 42 


CONTENTS.  IX 


LECTURE  VII. 

Tapeworm  Disorders  rarely  or  never  Incurable — Medical  Skill  occa- 
sionally baffled  for  a  Time — Mistakes  made  from  Carelessness 
in  Diagnosis — No  Excuse  for  such  Errors — Remarkable  Case 
(XXVI.)  in  which  a  Lady  was  for  Six  Years  treated  for  Tape- 
worm when  no  Parasite  existed — -Inferences  and  Suggestions 
arising  from  the  Consideration  of  the  Facts  of  this  Case — Final 
Reflections pp.  43—49 

LECTURE  VIII. 

Obstinate  Cases  will  occasionally  occur  in  Practice — Case  XXVII. 
— Instances  of  the  Value  of  Kousso — Cases  XXVIII.  and 
XXIX. — Large  Doses  of  Male-fern  may  give  rise  to  Symp- 
toms of  Jaundice — Rapidity  of  the  Growth  of  Tapeworms  shown 
by  the  Fact  that  in  the  last-named  Case  upwards  of  Sixty  Feet 
of  Tapeworm  were  developed  from  a  Single  Head  within  Eleven 
Months pp.  50 — 55 

LECTURE  IX. 

Comparative  Rarity  of  Obstinate  Cases — Reasons  for  not  attempting 
to  operate  on  the  Head  of  Worm  when  left  behind — Cases  XXX. 
and  XXXI.— The  best  Time  to  administer  Remedies  for  Tape- 
worm— Why  Caution  in  this  Respect  is  so  very  necessary — 
Case  XXXII. — Advantage  of  having  to  treat  Patients  who  are 
educated — Case  XXXIII. — Circumstances  under  which  Treat- 
ment should  be  delayed pp.  56 — 63 


LECTURE  X. 

Patients  are  commonly  only  pleased  with  Advice  which  is  in  entire 
Harmony  with  their  Preconceived  Ideas — Cases  XXXIV.  and 
XXXV. — Parsimonious  Reluctance  of  Wealthy  People  to  obtain 
Medical  Advice — Case  XXXVI.,  illustrating  the  Importance  of  a 
Correct  Opinion — Different  Species  of  Entozoa  are  sometimes 
associated  together— Case  XXXVII pp.  64—69 


CONTENTS. 


LECTURE  XI. 

The  Age  at  which  Tapeworm  most  commonly  occurs — Case 
XXXVIII. — Tapeworm  may  Attack  very  Young  Persons — 
Case  XXXIX.  —  Parasitism  may  be  masked  by,  or  compli- 
cated with,  various  other  Diseases — Cases  XL.  and  XLI. — 
The  Cucumerine  Tapeworm  of  the  Dog  has  been  found  in  Man- 
Necessity  for  Caution  in  identifying  the  Species — Opposed 
Genital  Pores  in  the  Proglottides  not  Conclusive— Case  XLIL— 
Remarkable  Cestode  Abnormality pp.  70—78 

LECTURE  XII. 

Prevalence  of  the  Seatworm  Disease— The  Children's  Pest— Wide 
Distribution  of  Oxyuris  vermicularis  —  The  Eggs  and  their 
contained  Embryos — Development  of  the  Larvae — Opinions  of 
Vix,  Leuckart,  Zenker,  and  Heller — Head-quarters  of  the  Adult 
Worm — Symptoms  produced  in  the  Human  Bearer  pp.  79 — 85 

LECTURE  XIII. 

Cases  XLIII.  to  LIL,  illustrating  the  more  ordinary  Methods  of 
Treatment — Employment  of  Santonin,  Podophyllin,  Areea  Nut, 
Chenopodium,  Buckthorn,  Salines,  Jalapin,  Scammony,  and 
other  Cathartics — Simple  and  Medicated  Enemata,  with  Lime- 
water,  Steel,  Sulphuric  Ether,  Quassia,  and  Tansy  pp.  86 — 93 


LECTURE  XIV. 

The  Parasitism  of  Threadworms  is  occasionally  complicated  by  other 
Diseases — Cases  LIII.  and  LIV. — Oxyurides  in  Children  are 
frequently  overlooked — Cases  LV.  to  LIX. — Insufficiency  of 
the  Ordinary  Remedies — Liability  of  the  Disorder  to  return  after 
apparently  effective  Treatment pp.  94—101 


CONTENTS.  XI 

LECTURE  XV. 

Salines  with  Enemata  constitute  the  most  effective  Treatment — 
Saline  Mineral  Waters  especially  recommended— Some  Patients 
cannot  bear  vigorous  Treatment  of  any  kind — Cases  LX.  to 
LXV.  —  Personal  Cleanliness  is  the  best  Preventive  against 
Infection  pp.  102— 110 

LECTURE  XVI. 

The  Ascarides  properly  so-called — Lumbrici  not  common  in  Eng- 
land— Ascaris  mystax  still  rarer  in  Man — Eggs  of  the  Round- 
worm  ejected  from  the  Stomach— Ascarides  common  Abroad — 
Symptoms  similar  to  those  produced  by  Oxyurides— Singular 
Habits  of  A  scaris  lumbricoides — Often  solitary  in  this  Country — 
Cases  LXVI.  to  LXX pp.  111—120 

LECTURE  XVII. 

Value  of  Santonin  in  Ascarides,  or  Lumbrici — Trichiniasis  first 
discovered  in  the  Living  Subject  by  Zenker — Symptoms  of  the 
Trichinous  Disease — Recent  Outbreak  in  England — Home-fed 
Swine  generally  free  from  this  Parasite — Dr.  Dickinson's  pub- 
lished Cases — His  claims  as  being  the  First  Person  to  recognise 
and  treat  the  Disease  in  England  alleged  to  have  been  dis- 
puted— Further  Explanation  required  ....  pp.  121—127 

LECTURE  XVIII. 

Imaginary  or  Spurious  Instances  of  Parasitism — Pseudhelminths 
sometimes  real — Bots,  Maggots,  and  other  Larvae  of  Insects — 
These  Cases  often  connected  with  Hysteria — Cases  LXXI.  to 
LXXV pp.  128—135 

LECTURE  XIX. 

Bots  from  the  Human  Intestinal  Canal — Difficulties  may  arise  as  to 
the  means  of  distinguishing  Genuine  from  Spurious  Cases — 
Maggots  may  lodge  beneath  the  Skin — Cases  LXXVI.  to 
LXXVJII. — The  Larvae  of  Flies  may  give  rise  to  disagreeable 
Symptoms— Cases  LXXIX.  to  LXXX.— The  Harvest  Bug  and 
the  Gigger pp.  136—142 


Xll  CONTENTS. 

LECTURE  XX. 

Flukes  or  Trematode  Parasites  are  comparatively  rare  in  Man — Tbe 
Bilharzia  hcematobia  forms  a  notable  exception — Formidable  Na- 
tureof  Disease  thus  produced — TheciliatedLarvse  of  this  Entozoon 
display  a  complicated  System  of  Aquiferous  Vessels — Case 
.  LXXXL— Comments  on  the  Peculiarities  of  the  Disease,  with  an 
Exposition  of  the  Principles  which  should  guide  us  in  the  Treat- 
ment of  Cases pp.143 — 155 


APPENDIX 157 

INDEX.  .    .    163 


LECTURES 


ON 


PEACTICAL  HELMINTHOLOGY, 


LECTURE  I. 

Parasitism  offers  a  new  Field  of  Research — Life,  History,  and  Eco- 
nomy of  the  Entozoa' — Teleological  Inferences— Serious  Maladies 
produced  by  Helminths — Demand  for  a  Special  Recognition  of 
this  Class  of  Diseases — General  Structure  of  the  Tapeworms--- 
Diagnostic  and  Prognostic  Value  of  a  Knowledge  of  the  Major 
Facts  of  Development — Case  I. — Tapeworms  are  derived  from 
Mutton,  Beef,  and  Pork. 

GENTLEMEN, — As  the  science  and  practice  of  our 
calling  advances,  it  necessarily  follows  that  new 
avenues  of  knowledge  are  continually  opening  up  to 
our  view,  and  those  of  us  who  are  not  afraid  of  "  toil 
and  trouble  "  may  rest  assured  that  a  hold  entry 
into  any  one  of  these  hitherto  unbeaten  paths  will 
not  only  bring  to  the  professional  investigator  a  rich 
increase  of  pleasant  (and  sometimes  of  unpleasant) 
knowledge,  but  will  enable  him  to  point  out  the 
means  of  checking,  if  not  of  entirely  eradicating 
a  variety  of  formidable  diseases. 

The  truth  of  this    general  statement  cannot  be 
B 


2  LECTURES. 

better  enforced  than  by  an  appeal  to  the  record 
of  our  recent  experiences  in  regard  to  the  life- 
history  and  economy  of  the  entozoa.  Here,  be 
pleased  to  observe,  we  have  a  group  of  creatures 
(hitherto  mysterious  to  us  in  respect  of  their  varied 
modes  of  origination  and  entry  into  the  human 
body)  showing  peculiarities  in  their  organization 
and  displaying  migratory  habits,  associated  with 
metamorphotic  changes  altogether  unique  ;  and  so 
strange  are  these  phenomena,  when  viewed  in  re- 
ference to  the  ends  accomplished,  that  I  believe 
I  am  not  going  too  far  in  stating  that  their  fair 
consideration  is  certain  to  overthrow  the  ordinarily 
received  opinions  of  teleologists  respecting  the  why, 
how,  and  wherefore  of  their  mere  existence. 

This,  however,  is  not  the  place  to  enter  upon 
speculations  which  can  tend  to  little  practical 
good ;  nevertheless  I  will  venture  to  remark  in 
passing  that  I  still  think  it  possible  to  entertain 
conceptions  of  original  causation  in  harmony 
with  the  doctrine  of  final  causes,  provided  only 
you  express  that  doctrine  in  terms  sufficiently 
wide. 

Be  that  as  it  may,  gentlemen,  it  is  perhaps 
sufficient  for  you  to  concern  yourselves  with  the 
fact  that  the  entozoa,  the  helminths,  the  intestinal 
worms,  or  call  them  what  you  will,  are  capable, 
both  individually  and  collectively,  of  producing  the 
gravest  of  maladies.  Thus  a  single  parasite,  no 


TAPEWORMS.  6 

larger  than  a  pea,  and  whose  presence  in  the  human 
body  shall  never  have  hitherto  occasioned  the 
slightest  inconvenience  to  the  "  bearer  "  of  it,  may, 
without  a  moment's  warning,  give  rise  to  instan- 
taneous death;  whilst,  on  the  other  hand,  collec- 
tions of  parasites,  each  individually  so  small  that 
thousands  of  them  might  be  placed  in  a  nutshell, 
are  capable  of  producing  equally  fatal  results,  some- 
times affecting  a  whole  community. 

Surely  then,  at  a  time  when  chairs  are  founded 
to  promote  the  knowledge  of  dermatology,  when 
societies  are  created  to  discuss  questions  of  epi- 
demiology, and  when  associations  are  formed 
solely  with  the  benevolent  purpose  of  advancing  the 
interests  of  public  health,  I  am  not  going  out  of 
the  way  in  insisting  more  precisely  than  has  hitherto 
been  done  on  the  claims  of  helminthology. 

With  these  preliminary  remarks,  let  us  attack 
our  subject  by  treating  of  those  human  parasites 
which,  though  not  the  most  common,  are  perhaps 
the  best  known — I  mean  the  tapeworms.  In  re- 
spect of  their  general  structure  and  development,  it 
is  important  to  remind  you  that  in  a  separate 
specimen,  such  as  is  ordinarily  obtained  from  the 
hospital,  you  have  to  deal  with  a  multiple  sort  of 
creature,  whose  various  "  joints "  or  segments, 
whether  sexually  mature  or  otherwise,  represent  so 
many  individual- like  beings  arranged  in  single 
file.  A  fully  developed  beef  tapeworm  numbers 
B  2 


4  LECTURES. 

about  eleven  hundred  of  these  "  joints."  Towards 
the  so-called  tail-end  of  the  tapeworm  the  segments 
become  more  and  more  perfectly  formed,  until  the 
lowermost — so  to  speak — breaks  off  from  the  colony 
in  order  to  assume  a  semi-independent  existence. 
These  separated  joints  are  the  "  cucurbitini "  of  old 
writers,  and  I  would  urge  you  particularly  to  fa- 
miliarize yourselves  with  the  appearances  presented 
by  them,  especially  whilst  they  are  still  alive.  I 
have  known  the  most  erroneous  statements  made 
and  published  respecting  their  true  nature,  and 
have  repeatedly  received  specimens  from  professional 
gentlemen,  by  post,  for  determination.  Serious 
errors  of  practice  have  also  occasionally  arisen  from 
this  source.  Sometimes  you  may  be  enabled, 
merely  by  a  naked-eye  examination  of  the  seg- 
ments, to  determine  the  particular  species  or  form 
of  tapeworm  from  which  your  patient  may  be 
suffering ;  unfortunately,  however,  most  of  the  eggs 
have  usually  escaped  from  the  "  joints"  passed  by 
stool,  and  in  this  way  the  distinctive  form  of  the 
uterine  cavity,  constituting  under  these  circum- 
stances the  best  diagnostic  mark  of  the  species,  is 
practically  lost.  A  much  more  important  point  for 
you  to  remember  in  any  case  that  may  present 
itself,  lies  in  the  circumstance  that  "joints"  only 
pass  where  the  worm  is  fully  developed.  In  the 
instance  of  the  beef  tapeworm  you  may  reckon  upon 
thirteen  weeks  as  the  extreme  time  necessary  for  the 


TAPEWORMS.  5 

full  growth  and  maturation  of  the  parasite,  and  the 
recollection  of  this  statement,  which  is  based  upon 
interesting  facts  occurring  within  my  own  expe- 
rience, wrill  often  prove  of  service  to  you  in  practice. 
Let  me  illustrate  it  by  a  case  in  point. 

CASE  I. — C.  B.  was  formerly  a  patient  under  the 
care  of  a  physician  residing  in  the  city.  On  two 
separate  occasions,  with  the  request  or  sanction  of 
his  medical  adviser,  he  called  to  ask  my  opiDion 
respecting  the  nature  of  the  parasite  he  had  passed^ 
chiefly  with  the  view,  I  presume,  of  forming  a 
correct  prognosis.  On  the  first  occasion  the  speci- 
men proved  to  be  an  incomplete  example  of  tcsnia 
mediocanellata.  As  the  head  was  not  present  I  advised 
him  to  submit  himself  to  the  same  excellent  course 
of  treatment  (that  had  been  previously  adopted) 
should  the  parasite  return,  adding  that  he  need 
not  look  for  its  return  until  the  expiration  of 
about  three  calendar  months.  On  the  occasion 
of  his  second  visit  (June  17,  1865)  he  brought 
me  a  perfect  specimen  of  the  beef  tapeworm 
with  the  head  attached,  and  what  was  equally 
satisfactory  to  me,  he  at  the  same  time  expressed 
his  astonishment  that  the  reappearance  of  the  worm 
should  have  occurred  on  the  very  day  when  the 
interval  of  thirteen  weeks  had  elapsed.  The 
patient's  mind  being  now  completely  relieved  by  my 
assurances  to  the  effect  that  he  had  no  other  parasite 
left  behind,  and  that  it  was  impossible  for  the 


b  LECTURES. 

present  tapeworm  to  redevelop  itself,  the  cure  was 
pronounced  to  be  in  all  respects  complete. 

In  this  connexion  I  have  further  to  observe  that 
a  careful  examination  of  the  "joints"  of  several 
different  tapeworms  will  convince  you  of  their 
liability  to  vary  in  character,  so  that  the  same 
sets  of  segments,  thus  to  speak,  are  not  always 
alike.  In  the  examples  before  you  some  are 
characterized  by  a  few  and  others  again  by  many 
branchings  of  the  uterine  cavity.  In  well-marked 
types,  therefore,  you  would  experience  no  difficulty 
in  referring  some  to  the  tapeworm  derived  from 
beef  and  others  to  the  form  derived  from  pork. 
Here,  you  perceive,  is  an  extreme  form  which 
I  believe  to  be  characteristic  of  the  tapeworm 
obtained  from  the  ingestion  of  imperfectly  cooked 
mutton.  "Measly  mutton"  and  "measly  beef" 
are  terms  which  will  sound  strange  to  those  who 
know  of  no  other  "  measled  meat"  than  pork ;  but 
my  investigations  (as  you  see  in  part  by  the  speci- 
mens of  "measly  beef"  before  you)  have  incon- 
testably  proved  and  verified  the  fact  of  the  existence 
of  larval  tapeworms  in  the  most  esteemed  kinds  of 
animal  food. 


LECTURE  II. 

Necessity  of  distinguishing  the  various  kinds  of  Tapeworm— Means 
of  Identification — Diseases  often  produced  by  the  Larvae  of  Para- 
sites —  Cerebral  Symptoms  from  Cysticerci  —  Natural  Cures 
effected  by  Calcareous  Degeneration  of  the  Larvae — Duration  of 
the  Life-epoch  of  the  Beef-measle — Hydatids  apt  to  be  con- 
founded with  Cysticerci — Degree  and  Variety  of  Symptoms  pro- 
duced by  Tapeworm — The  worst  Symptoms  may  remain  after  a 
Cure  has  been  effected — Case  II. 

GENTLEMEN , — At  the  close  of  my  opening  lecture 
you  will  remember  that  I  was  more  particularly 
insisting  upon  the  necessity  of  distinguishing  three 
of  the  various  tapeworms  liable  to  infest  the  human 
body ;  but  in  addition  to  the  facts  already  men- 
tioned in  that  connexion,  let  me  also  remind  you 
that  the  heads  of  these  tapeworms  are  severally 
distinct,  as  are  also  the  so-called  "  heads"  of  the 
measles  or  Cysticerci  whence  they  are  developed. 
The  head  of  the  beef  tapeworm  is  destitute  of 
hooks,  and  has  four  large  suckers,  besides  a  central 
supplementary  fifth  (so-called),  whilst  the  head  of 
the  pork  tapeworm  is  a  trifle  smaller,  and  furnished 
with  a  slightly  prominent  proboscis  armed  with  a 
double  row  of  hooks.  The  mutton  tapeworm  is 
also  armed ;  at  least  the  "  measle"  is  supplied  with 


8  LECTURES. 

hooks,  as  was  also  the  head  of  the  tapeworm  whence 
I  procured  those  extreme  types  of  segments  already 
brought  under  your  notice.  Other  minor  characters, 
yet  equally  distinctive  as  between  the  beef  and  pork 
varieties,  may  be  seen  in  the  microscopic  prepara- 
tions on  the  table. 

In  the  course  of  practice  you  may  meet  with 
disorders  produced  both  by  the  larval  and  adult 
conditions  of  the  tapeworm.  It  is  true  that  the 
first-mentioned  cases  are  extremely  rare  ;  neverthe- 
less I  am  confident  that  they  are  not  so  uncommon 
as  is  usually  supposed.  The  symptoms  produced 
by  larval  tapeworms,  or  cysticerci,  in  the  human 
body,  are  liable  to  be  overlooked,  especially  when 
these  parasites  have  taken  up  their  residence  within 
the  brain.  Probably  not  fewer  than  one  hundred 
such  instances  have  occurred  within  medical  expe- 
rience; at  all  events,  fifty  such  cases  have  been 
collected  or  placed  on  record  by  a  single  author 
(Gricsinger).  It  has  been  shown  by  these  cases 
that  you  may  have  a  variety  of  cerebral  symptoms, 
from  simple  giddiness  and  headache  up  to  the  most 
severe  and  alarming  epileptiform  seizures,  solely 
brought  about  by  the  presence  of  one  or  more 
larval  tapeworms  in  the  human  brain.  It  does  not 
appear,  indeed,  that  any  of  the  symptoms  are 
sufficiently  characteristic  to  enable  you  to  dis- 
tinguish them  from  mental  perturbations  caused  by 
other  lesions  or  disorders ;  nevertheless,  it  is  just 


TAPEWORMS.  U 

possible,  taking  the  history  of  the  patient  into  con- 
sideration, that  you  might  be  able  to  diagnose  such 
a  case  successfully.  Undoubtedly  also  your  suspicions 
would  be  very  naturally  roused  if  in  any  person  suf- 
fering under  cerebral  disturbance  you  should  have 
previously  obtained  evidence  of  the  existence  of  cysti- 
cerci  in  other  parts  of  the  body — say,  for  example, 
in  the  eye  or  beneath  the  skin.  As  to  the  possi- 
bility of  a  cure  being  effected  in  the  case  of  a 
cerebral  cysticercus,  I  for  one  (supposing  a  correct 
diagnosis  had  been  arrived  at)  should  not  entirely 
despair ;  for  in  this  particular  relation  my  experi- 
mental investigations  have  taught  me  an  important 
practical  lesson.  I  have  found  and  demonstrated 
that  the  larvse  of  the  beef  tapeworm,  if  left  to  them- 
selves, will  perish  and  calcify  within  a  period  of 
about  eight  months.  From  actual  observation  I 
have  ascertained  that  the  same  pathological  process, 
tending  in  all  cases  to  a  natural  cure,  is  sooner  or 
later  accomplished  in  other  forms  of  larval  tape- 
worms, whether  encountered  in  the  human  body 
or  elsewhere.  In  true  hydatids  the  time  requisite 
for  a  natural  cure  is  necessarily  much  longer  than 
obtains  in  the  case  of  ordinary  cysticerci;  conse- 
quently it  may  be  doubted  if  any  cure  of  this  sort 
has  ever  followed  in  the  instances  where  these  larger 
kinds  of  larvae  have  gained  access  to  the  human  brain. 
Knowing  what  cures  are  effected  by  the  veterinarian 
in  cases  of  "gid,"  I  should  not  at  all  despair  of 


10  LECTURES. 

such  a  result.  In  severe  cases  of  cerebral  cysti- 
cercus,  shown  to  have  been  such  by  post-mortem 
appearances,  the  epileptic  fits  were  commonly  suc- 
ceeded by  torpor  and  loss  of  consciousness,  gradually 
terminating  in  death.  In  autopsies  resulting  from 
brain  affections,  should  any  cysticercal-like  produc- 
tions be  found,  be  on  your  guard.  In  several  cases 
recorded  as  hydatids  the  authors  have  really  been 
dealing  with  examples  of  the  ordinary  cysticercus, 
whilst  in  others  the  observers  (like  Fredault)  have 
referred  common  cysticercal  developments  to  dis- 
tinct and  hitherto  undescribed  species  of  entozoa. 
A  little  attention  to  the  facts  I  have  placed  before 
you,  coupled  with  an  inspection  of  the  specimens, 
should  be  sufficient  to  prevent  the  recurrence,  on 
your  part,  of  any  similar  error. 

Leaving  for  future  consideration  the  subject  of 
hydatids,  which  not  only  concerns  the  surgeon,  but 
has  important  bearing  on  questions  of  public  health, 
let  us  now  consider  the  symptoms  liable  to  result 
from  the  presence  of  tapeworms  in  the  intestinal 
canal.  Occasionally,  indeed,  the  "  bearer"  is  fortu- 
nate enough  to  experience  no  marked  inconveni- 
ence ;  but,  as  I  have  elsewhere  stated,  such  instances 
of  immunity  are  rather  apparent  than  real.  The 
exemption  is  apparent  only,  "  inasmuch  as  the  para- 
site gradually,  and  to  the  patient,  as  it  were,  unknow- 
ingly, steals  away  a  portion  of  his  health.  The 
trifling  feelings  of  weariness  and  lassitude  are 


TAPEWORMS.  11 

usually  set  down  to  other  causes;  and  it  is  only 
when  these  indications  are  succeeded  by  restless- 
ness, nervous  irritability,  and  headache  that  proper 
attention  is  paid  to  the  true  source  of  the  malady." 
Kather  than  take  proper  advice,  many  persons  will 
endure  the  annoyances  arising  from  the  frequent 
passage  of  the  segments  per  mas  naturales.  To 
refined  and  educated  minds,  however,  the  mere  idea 
of  harbouring  such  creatures  as  tapeworms  is  re- 
volting in  the  extreme ;  consequently  such  patients 
display  the  greatest  possible  anxiety  to  be  quickly  rid 
of  their  "  guests."  Although  the  gravest  symptoms 
are  now  and  then  encountered,  it  is  fortunately 
not  often  that  the  disease  proves  dangerous  to  life. 
"  In  bad  cases  the  headache  is  much  increased,  and 
often  accompanied  with  giddiness;  the  sight  and 
hearing  may  be  affected  ;  noises  in  the  head,  itchings 
at  the  nose  and  anus,  obscure  pains  about  the  body 
and  limbs,  loss  of  appetite,  and  other  dyspeptic 
symptoms  show  themselves  in  greater  or  less  degree 
in  different  cases.  One  of  the  most  common 
symptoms  I  have  noticed  is  a  tendency  to  faintness. 
This  is  occasionally  so  marked  as  to  create  alarm, 
and  a  person  uninformed  as  to  the  true  cause  of 
the  disorder  might  be  led  to  treat  this  symptom  as 
coming  from  a  totally  different  source.  In  females 
the  nervous  phenomena  display  features  more  or 
less  peculiar  to  the  sex.  The  restlessness  and 
anxiety  are  excessive,  and  at  times  accompanied 


12  LECTURES. 

with  chorea  and  fits  of  hysteria.  In  the  worst  cases 
of  both  sexes  the  cerebral  disturbance  may  show 
itself  in  convulsions  and  epileptiform  seizures ;  and 
I  regret  to  add  that  in  not  a  few  instances  even 
mania  itself  has  been  entirely  attributable  to  the 
presence  of  these  entozoa  in  the  intestinal  canal/' 
In  the  "  bibliography"  of  my  larger  treatise  you 
will  find  references  to  several  of  these  sad  cases; 
and  the  worst  of  it  is  (when  the  cases  are  of  long 
standing),  the  nervous  accompaniments  may  remain 
even  after  you  have  cured  your  patient.  In  the 
briefest  possible  terms  let  me  give  you  an  instance 
of  this  kind  from  my  owp  experience. 

CASE  II. — H.  J.,  a  lady,  consulted  me  in  regard  to 
a  tapeworm  she  had  contracted  eleven  years  pre- 
viously. She  had  been  most  injudiciously  treated 
abroad ;  amongst  other  things,  taking  constantly 
large  draughts  of  tar-water.  After  a  second  inter- 
view, I  satisfied  myself  not  only  that  she  had  no 
tapeworm  when  she  first  came  to  me  (Nov.  10, 
1866),  but  that  she  and  her  guest  had  parted  com- 
pany fully  five  years  previously.  Notwithstanding 
my  assurances, all  efforts  failed  to  convince  the  patient 
that  a  cure  had  been  effected.  She  had  been  all 
along,  and  I  believe  still  is,  subject  to  the  most 
distressing  seizures,  the  sudden  hysterical  fits  being 
accompanied  with  violent  muscular  contractions, 
rendering  the  body  quite  opisthotonic.  These  and 
other  bad  nervous  symptoms  were,  I  believe,  origi- 


TAPEWORMS.  13 

nally  due  to  the  irritation  set  up  by  the  tapeworm 
acting  upon  a  morbidly  sensitive  constitution.  It 
is  one  of  those  chronic  cases  in  which  our  best 
efforts  are  necessarily  baffled ;  but  had  a  different 
method  of  treatment  been  adopted  from  the  very 
first,,  I  am  of  opinion  that  this  patient  would  have 
been  permanently  cured. 


LECTURE  III. 

Nervous  Symptoms  erroneously  ascribed  to  Tapeworm — Caselll. — 
Necessity  of  being  free  from  Doubt  as  to  the  Presence  or  Absence 
of  Parasites — The  Patient's  Mind  must  be  fully  informed  and 
satisfied — Cases  IV.  to  VIII.  serve  to  illustrate  this  Point- 
Supreme  Importance  of  a  correct  Diagnosis — Parasitic  Diseases 
frequently  overlooked — The  Proper  Remedies  for  Tapeworm — 
Anthelmintics  to  be  employed  with  Discrimination — Prevalence 
of  the  Beef  Tapeworm. 

GENTLEMEN, — In  my  last  discourse  I  dwelt  espe- 
cially upon  the  various  symptoms  to  which  patients 
are  liable  when  infested  by  tapeworms ;  and  you 
will  remember  that  I  laid  particular  stress  on  the 
nervous  phenomena  more  commonly  met  with. 
Finally,  I  offered  you  an  instance  where  some  of 
the  worst  concomitants  of  this  kind  had  remained, 
long  after  the  parasite  had  been  got  rid  of.  Let 
me  now  offer  you  a  case  of  a  somewhat  different  cha- 
racter; in  which,  however,  the  persistent  symptoms 
were  again  erroneously  attributed  to  the  actual  pre- 
sence of  tapeworm. 

CASE  III. — A.  L.,  a  gentteman,  from  Hertford- 
shire, has  long  been  treated  for  tapeworm  by 
practitioners  of  distinction ;  but  when  I  first  saw 
him  (March  27,  1869)  he  admitted,  in  the  course 


TAPEWORMS.  15 

of  a  prolonged  consultation,  that  he  had  not  passed 
any  portions  of  a  worm  (such  as  I  described  to 
him).  Indeed,  I  almost  doubt  if  he  ever  had  tape- 
worm, though  he  appears  to  have  had  other  entozoa. 
Headache,  restlessness,  with  strange  abdominal 
pains,  were  all  ascribed  to  the  presence  of  tape- 
worm ;  and  it  was  in  vain  that  I  offered  proofs  of 
the  non-existence  of  the  parasite.  Under  these 
circumstances,  I  naturally  recommended  this  hypo- 
chondriacal  subject  to  repair  to  one  of  our  English 
spas.  Whilst  enjoying  the  change,  his  general 
health  received  considerable  benefit ;  but  unfor- 
tunately he  still  entertains  the  idea  that  he  is  in- 
fested by  a  tapeworm. 

In  most  of  these  spurious  cases,  where  the 
symptoms  have  not  been  of  very  long  duration, 
though  in  the  first  instance  clearly  attributable  to  a 
tapeworm,  you  will  find  no  difficulty  in  relieving 
the  mind  of  the  patient.  It  is  particularly  necessary, 
however,  that  you  should  yourselves  be  utterly  free 
from  doubt  as  to  the  true  state  of  affairs.  Some 
patients  will  willingly  undergo  a  fresh  course  of 
treatment,  even  though  you  may  have  been  able  to 
satisfy  your  own  mind  that  such  a  step  is  unnecessary 
and  may  have  been  at  some  pains  to  explain  your 
views.  Here  are  several  illustrative  cases  occurring 
in  my  practice.  ^ 

CASE  IV. — G.  W.  Gr.,  a  gentleman,  came  direct 
from  California  to  consult  me  (July  13,  1869) 


16  LECTURES. 

respecting  a  tapeworm  which  has  troubled  him 
for  six  years  past.  For  the  cure  of  it  he  has  taken 
large  doses  of  turpentine  and  other  drugs.  The 
consideration  that  fully  three  months  had  elapsed 
since  he  last  passed  any  of  the  worm  (as  a  result 
of  treatment),  coupled  with  the  circumstance  that 
he  was  not  at  the  time  passing  "  segments,"  at 
once  enabled  me  to  express  my  belief  that  he  was 
already  relieved  of  his  enemy.  The  correctness  of 
this  opinion  was  subsequently  confirmed  by  the 
absolutely  negative  results  obtained  after  a  most 
vigorous  course  of  treatment — a  measure  which  I 
found  necessary  to  adopt  in  order  to  dispel  all 
doubt  and  difficulty  in  the  patient's  mind. 

CASE  V. — C.A.,ageritleman,resident  at  Edinburgh, 
wished  to  go  through  a  course  of  treatment  for 
tapeworm.  As  he  had  not  noticed  the  passage  of 
"  joints"  for  an  interval  of  something  like  a  year,  I 
explained  to  him  (June  15, 1868),  that  any  remedial 
measures  would  probably  only  secure  a  negative 
result.  Having  taken  certain  medicines  which  I  pre- 
scribed, without,  of  course,  passing  any  tapeworm, 
this  patient  had  also  the  good  sense  to  rest  satisfied 
as  to  the  correctness  of  the  opinion  I  originally 
offered. 

CASE  VI. — R.  A.  consulted  me  (September  11, 
18G9)  in  reference  to  obscure  pains  in  the  throat 
and  other  parts  of  the  body,  which  he  attributed 
to  the  presence  of  tapeworm.  This  gentleman's 


TAPEWORMS.  17 

case  was  not  unlike  that  of  the  one  marked  No. 
III.,  the  hypochondriacal  symptoms  being  accom- 
panied with  anorexia,  nausea,  and  vertigo.  How- 
ever, I  was  satisfied  that  this  patient  had  really 
suffered  from  tapeworm  some  time  previously ;  and 
when  I  fully  explained  to  him  that  the  depression 
under  which  he  laboured  was  entirely  due  to  other 
causes,  he  was  satisfied  to  adopt  a  simple  restorative 
treatment  such  as  I  then  advised. 

CASE  VII. — R.  J.  J.,  a  gentleman,  residing  at 
the  west-end  of  London  (November  22,  1867),  con- 
tracted tapeworm  about  six  years  previously.  He 
had  been  treated  for  the  disease,  and  although  he 
was  not  aware  that  he  had  passed  any  "  segments" 
for  five  months  past,  he  was  nevertheless  convinced 
that  the  creature  was  present  internally.  After  a 
thorough  trial  of  appropriate  remedies,  I  here  also 
fortunately  succeeded  in  convincing  the  patient  that 
he  laboured  under  a  delusion  ;  and  I  have  the  satis- 
faction of  knowing  that  he  has  had  no  return  of 
the  disorder. 

CASE  VIII.— H.  H.  W.  is  an  Indian  officer,  who 
contracted  tapeworm  in  the  Punjaub  between  three 
and  four  years  back.  He  consulted  me  (September 
27,  1869),  being  at  the  time  impressed  with  the 
belief  (which  was  also  shared  by  his  usual  Medical 
adviser),  that  he  was  still  afflicted  with  the  parasite. 
Though  suffering  from  pulmonary  disease,  much  of 
his  debility  was  attributed  to  the  tapeworm.  In 

c 


18  LECTURES. 

this  case  it  became  necessary  to  adopt  active 
remedial  measures  under  circumstances  of  unusual 
difficulty ;  and  the  treatment  succeeded  in  so  far  as 
it  enabled  me  to  satisfy  my  own  mind  and  the 
patient's  that  he  had  been  effectually  cured  by 
the  last  course  of  remedies  adopted  prior  to  the 
date  of  his  asking  my  advice. 

The  foregoing  cases  should,  I  think,  be  sufficient 
to  convince  you  that  the  knowledge  necessary  to 
give  a  correct  opinion  in  cases  of  parasitic  disease, 
is  not  so  simple  a  matter  as  some  would  have  you 
suppose.  The  above  constitute  only  a  very  small 
proportion  of  the  cases  which  have  come  under  my 
attention  where  entozoa  were  suspected  when  there 
was  no  legitimate  ground  for  such  suspicions.  On 
the  other  hand,  it  may  be  safely  averred  that  cases 
of  parasitic  disease  are  not  unfrequently  overlooked 
by  those  who  have  not  deemed  the  subject  of 
sufficient  importance  to  require  their  study. 

Putting  aside  for  the  present  these  general 
truths,  let  us  consider  what  are  our  resources  in 
cases  of  undoubted  tapeworm.  I  shall  take  occa- 
sion to  enter  more  fully  upon  this  subject  in  the 
next  lecture  (p.  22) ;  but  in  the  meantime  I  may 
remark  that  some  practitioners  seem  to  think  that 
one  vermifuge  is  as  good  as  another,  and  administer 
all  kinds  indiscriminately.  I  suppose  that  the 
principle  they  go  upon  is  based  upon  the  notion 
that  vermifuges  in  general  act  mechanically  upon 


TAPEWORMS.  19 

the  intestine  and  its  contents,  literally  scouring 
the  patient's  bowels  and  driving  everything  before 
them.  Now,  to  tell  the  truth,  treatment  on  this 
pop-gun  sort  of  principle  is  sometimes  temporarily 
successful,  and  you  may  occasionally  drive  out  ten 
or  fifteen  feet  of  a  tapeworm  merely  by  a  vigorous 
dose  of  jalap  or  castor  oil.  In  such  cases,  however, 
you  must  not  expect  to  secure  or  dislodge  the  head 
of  the  parasite ;  the  tapeworm  will,  therefore,  cer- 
tainly grow  again.  To  be  sure,  I  do  not  say  that 
in  every  case  where  you  employ  the  proper  remedial 
agents  that  you  must  invariably  succeed;  indeed, 
in  cases  where  you  have  to  deal  with  the  armed 
varieties  of  tapeworm  you  will  rarely  obtain  the 
head.  Fortunately,  however,  as  my  investigations 
and  experiences  have  especially  shown,  the  unarmed 
beef  tapeworm  is  the  particular  species  most  com- 
monly encountered  in  private  practice. 


c  2 


LECTURE  IV. 

Illustrations  of  the  Relative  Value  of  Particular  Drugs— Cases  IX. 
and  X. — Uselessness  of  Santonin  in  Tapeworm — Impropriety  of 
giving  Remedies  which  exert  no  Poisonous  Action  on  the  Para- 
site— Reasons  for  Discountenancing  the  Employment  of  the  Oil 
of  Turpentine — Case  XI.  affords  an  instance  of  the  Anthelmintic 
Activity  of  Turpentine,  the  Head  being  dislodged  under  circum- 
stances of  peculiar  interest — No  necessity  for  long  Fasting  before 
taking  Vermifuges — Relative  Merits  of  Kousso  and  Male- fern — 
Case  XII.,  in  which  the  Head  of  the  Worm  was  Found. 

GENTLEMEN, — Towards  the  close  of  my  last  lecture 
I  was  speaking  of  the  inappropriateness  of  certain 
remedies  still  commonly  in  vogue.  Here  are  two 
cases  bearing  upon  the  point  then  raised. 

CASE  IX. — K.  H.,  a  captain  in  the  Royal  Fusiliers, 
consulted  me  on  the  23rd  of  July,  1869.  He  had 
contracted  tapeworm  in  India  four  years  previously, 
and  had  taken  the  usual  remedies  without  more 
than  a  partial  success.  He  suffered  from  anorexia, 
nausea,  vertigo,  and  general  loss  of  health.  By  the 
male-fern  method  of  treatment  I  brought  away  no  less 
than  sixteen  feet  of  a  pork- tapeworm,  some  of  the 
lowermost  neck-segments  being  present.  No  further 
treatment  being  at  the  time  pursued,  and  there 
being  no  evidence  that  the  head  was  expelled,  this 


TAPEWORMS.  21 

seemed  to  me  to  be  one  of  the  cases  in  which  I 
might  have  reason  to  believe  that  the  worm  would 
reappear ;  and  I  may  so  far  anticipate  what  I  have 
to  say  upon  the  subject  of  anthelmintics  by  remark- 
ing that  this  patient  had  previously  taken  kousso, 
kamala,  and  turpentine. 

CASE  X. — C.  M.,  a  delicately  nurtured  child,  in 
her  fourth  year,  was  recommended  to  see  me  re- 
specting a  tapeworm  which  she  also  had  contracted 
in  India.  The  Medical  gentleman  who  thus  advised 
had  himself  successfully  expelled  fourteen  feet  of  the 
parasite  by  means  of  a  simple  dose  of  calomel  and 
jalap.  At  the  time  (May  20,  1869)  it  was  evident 
that  the  head  and  greater  part  of  the  neck  remained 
behind,  but  there  were  circumstances  which  induced 
me  to  attempt  their  separate  expulsion.  No  result, 
however,  having  been  directly  obtained  in  this  way, 
and  it  being  clear  that  we  had  to  deal  with  the 
pork-tapeworm,  I  awaited  the  return  of  the  fully 
developed  worm,  segments  of  which  appeared  at  the 
expiration  of  ten  weeks.  I  now  administered  a 
suitable  dose  of  male-fern  and  brought  away  twelve 
feet  of  the  parasite.  Though  not  so  lengthily  de- 
veloped as  the  previously  expelled  specimen,  it  was 
a  much  more  perfect  individual — so  to  speak — the 
finer  and  uppermost  neck-segments  being  among 
the  dislodged  fragments.  As  I  had  no  opportunity 
of  myself  searching  for  the  head,  it  appeared  to  me 
quite  possible  though  scarcely  probable  that  the 


22  LECTURES, 

head  was  also  dislodged.  Eventually  it  turned  out 
that  a  perfect  cure  had  been  accomplished,  and  that 
the  head  of  the  worm  had  been  passed ;  doubtless, 
at  the  time  the  very  fine  neck-segments  had  come 
away.  The  child  has  since  had  no  return  of  the 
parasite. 

The  above  cases  offer  every  encouragement  to 
those  who  administer  male -fern  remedies  in  a  proper 
manner ;  for  although  in  the  treatment  of  the  pork 
and  mutton  tapeworms  you  may  occasionally  be 
baffled,  it  is  satisfactory  to  know  that,  with  proper 
care,  you  are  not  likely  to  be  otherwise  than  suc- 
cessful with  the  unarmed  variety  derived  from  beef. 
This  will  be  made  more  obvious  immediately. 
Meantime,  let  me  call  your  attention  to  all  the 
more  important  drugs  commonly  employed.  This  I 
shall  do  in  terms  very  similar  to  those  I  have 
adopted  in  the  small  treatise  previously  referred  to. 
"  The  remedies  for  tapeworm  are  male-fern,  kousso, 
kamala,  turpentine,  panna,  pumpkin-seeds,  and 
pomegranate-root  bark.  The  right  administration 
of  any  one  of  these  is  likely  to  produce  the"  desired 
result ;  but  many  other  drugs  have  been  and  still 
are  employed  with  more  or  less  success.  Patients 
have  consulted  me  after  trying  five  or  six  of  the 
above-named  remedies,  to  say  nothing  of  others  not 
worth  mentioning.  Some  Practitioners,  as  I  have 
said,  seem  to  think  one  vermifuge  as  good  as 
another.  Because  they  find  santonin  a  useful  remedy 


TAPEWORMS.  23 

in  threadworm,  and  almost  a  specific  in  round  worm, 
it  by  no  means  follows  that  the  same  drug  is  effec- 
tive, or  even  of  the  slightest  value,  in  tapeworm. 
When  so  many  excellent  tapeworm  vermifuges 
abound,  it  becomes  a  waste  of  time  to  dwell  on  the 
virtues  of  second-  and  third-rate  drugs,  such  as 
oxide  of  silver,  tin,  scammony,  jalap,  and  various 
other  drastic  purgatives  which  exert  no  poisonous 
influence  upon  the  worm."  Dr.  Shapter,  of  Exeter, 
has  employed  chloroform  with  success;  at  least, 
speaking  of  one  or  more  cases  thus  treated,  he  says, 
"  The  cure  was  effectual,  and  without  distress  of 
any  kind."  Now,  supposing  it  were  really  necessary 
to  try  several  drugs  in  succession,  I  would  recom- 
mend their  adoption  separately  in  the  order  I  have 
just  placed  them.  Of  course  in  no  individual  case 
will  you  ever  be  called  upon  to  indulge  in  such  a 
practice.  Without  asserting  their  actual  relative 
value  as  tapeworm  poisons,  I  give  them  a  preference 
in  the  order  in  which  they  are  here  recorded.  Pro- 
bably, as  I  have  elsewhere  said,  there  is  no  better 
remedy  for  tapeworm  than  oil  of  turpentine,  and 
yet  its  nauseous  character,  combined  with  the 
fact  that  it  not  unfrequently  produces  irregular 
and  violent  effects  upon  the  nervous  system, 
are  circumstances  always  inducing  me  to  sub- 
stitute other  drugs.  From  cases  which  have 
come  tinder  my  notice  I  have  no  doubt  what- 
ever as  to  the  great  anthelmintic  virtues  of  tur- 


24  LECTURES. 

pentine.  Here  is  a  simple  instance  of  its  value  and 
activity : — 

CASE  XI. — L.  R.  E.,  a  Cambridge  undergraduate, 
after  and  in  consequence  of  listening  to  a  paper  of 
mine  on  the  subject  of  entozoa,  is  impressed,  cor- 
rectly enough,  with  the  belief  that  he  is  infested 
by  a  tapeworm.  Having  some  knowledge  of  medi- 
cine, he  resolved  to  subject  himself  to  the  ordeal  of 
taking  a  large  dose  of  turpentine,  and  very  soon 
succeeded  in  bringing  away  the  parasite.  This 
gentleman  subsequently  sent  me  a  full  description 
of  the  specimen,  accompanied  with  a  pen-and-ink 
sketch  of  the  head  and  neck.  The  data  thus  sup- 
plied enabled  me  to  decide  that  the  tapeworm  was 
a  fine  example  of  the  kind  derived  from  beef. 

The  treatment  in  the  case  just  given  may  be 
recorded  as  a  " lucky  hit" for  I  have  known  similar 
steps  adopted  under  proper  medical  care  without 
any  result  whatever.  One  person  will  bear  this 
drug  with  impunity,  whilst  another  will  complain 
that  it  "  affects  his  head."  In  any  case  the  ad- 
ministration should  be  cautiously  carried  out, 
castor-oil,  or  some  other  cathartic,  being  added  to 
ensure  a  rapid  action.  I  may  here  mention  that 
Mrs.  Garrett  Anderson  informs  me  that  she  has 
treated  between  thirty  and  forty  dispensary  cases 
with  turpentine  and  castor-oil,  this  remedy  having 
"  never  failed  to  bring  away  the  worm  where  it  has 
been  known  to  be  present."  With  other  drugs 


TAPEWORMS.  25 

some  preliminary  steps  may  be  advisable ;  but  long 
fasting  prior  to  their  administration  is,  in  my 
judgment,  a  ee  great  mistake."  The  important  thing 
is  to  be  sure  that  your  pharmaceutical  preparations 
are  the  very  best  that  can  be  made.  Inferior 
drugs  will  cause  you  much  disappointment;  and, 
of  course,  some  forms  of  the  same  drug  are  better 
than  others.  For  example,  I  would  say  "  rarely 
administer  the  powdered  male-fern  root  if  you  can 
get  a  properly  made  ethereal  extract.  The  powder 
is  liable  to  lose  its  strength  by  long  keeping,  and 
it  is  perhaps  more  easily  adulterated  than  the  ex- 
tract. This  rule  applies  to  other  anthelmintics  also. 
I  have  cured  cases  of  tapeworm  with  the  oil  of 
male-fern  where  the  powdered  root  was  of  little 
or  no  service/'  Herein  also  lies  some  hindrance 
to  the  employment  of  that  really  excellent  drug 
kousso,  and  perhaps  also  to  some  extent  with  the 
powdered  areca-nut.  With  this  remedy  I  have  had 
some  experience  in  private  practice;  and  in  hospital 
cases  treated  by  Dr.  John  Barclay  it  has  been  pre- 
scribed with  very  remarkable  success.  I  believe  he 
first  introduced  this  particular  remedy  into  British 
practice.  The  large  quantity  of  kousso  required  to 
be  swallowed  is  highly  objectionable,  especially  in 
the  case  of  young  children.  Even  the  administra- 
tion of  decoctions,  as  in  the  instance  of  pome- 
granate-root bark,  is  not  without  some  similar 
disadvantage  as  regards  results.  My  own  expe- 


26  LECTURES. 

riences  have  given  me  great  confidence  in  the 
so-called  oil  of  male-fern  when  properly  prepared ; 
and  in  proof  of  the  fact  that  I  do  not  over-estimate 
its  therapeutic  value,  I  shall  now  direct  your  atten- 
tion to  a  considerable  series  of  instructive  and 
highly  successful  cases  : —  / 

CASE  XII. — S.  G.,  a  respectable  young  man,  had 
suffered  from  tapeworm  for  a  period  of  five  years, 
during  which  time  he  had  taken  a  variety  of  drugs. 
At  the  time  I  saw  him  (July,  1865)  he  was  much 
emaciated,  had  marked  cerebral  symptoms,  extreme 
depression,  and  a  suicidal  tendency.  He  had  at 
length  been  successfully  treated  by  an  able  medical 
practitioner,  who,  however,  had  sent  him  to  me  to 
pronounce  upon  the  worm  which  had  come  away, 
and,  in  fact,  to  give  a  "  prognosis "  of  the  case. 
On  careful  examination  of  the  materials  brought  by 
the  patient  I  found  all  the  parts,  including  the 
head,  of  a  well-developed  beef-tapeworm, 


LECTURE  V. 

Caution  to  be  Observed  before  definitely  Pronouncing  a  Cure — 
Case  XIII.,  where  Two  Worms  existed,  and  One  Head  only 
came  away — Always  Search  for  the  Head  of  the  Worm  if 
possible — Case  XIV.  gives  a  Cure  in  which  the  Vision  was 
Affected,  the  Head  of  the  Worm  not  having  been  Sought  For — 
Cases  XV.  to  XIX.  afford  Instances  of  Cures  where  the  Head 
of  the  Worm  was  either  not  Discovered,  or  not  sufficiently 
Searched  for — A  Trichocephalus  dislodged  by  the  Action  of 
Male-fern. 

GENTLEMEN, — Ere  I  pass  to  the  next  case,  let  me 
caution  you  as  to  pronouncing  definitely  upon  a 
cure  in  all  cases  where  you  may  be  fortunate 
enough  to  discover  the  head.  Of  course,  if  only 
one  parasite  be  present  your  prognosis  may  be  ab- 
solute in  the  patient's  favour;  but,  like  a  good 
accoucheur,  always  consider  the  possibility  of  en- 
countering twins.  Here  is  a  case  which  occurred 
to  myself: —  / 

CASE  XIII. — S.  S.  W.,  an  engineer,  who  had 
contracted  tapeworm  in  India  some  three  or  four 
years  previously,  and  who  had  frequently  taken 
kousso  and  other  drugs  without  success,  placed 
himself  under  my  care  in  April,  1867.  Except 
some  trifling  discomfort  arising  from  the  escape  of 


28  LECTURES. 

the  " joints"  per  anum,  he  had  suffered  nothing 
from  its  presence.  In  this  instance  a  single  ad- 
ministration of  the  male-fern  extract,  followed  by 
a  suitable  purgative,  brought  away  about  ten  feet 
of  a  tapeworm  at  the  first  movement  of  the  bowels, 
the  remainder  of  the  parasite,  including  the  head, 
not  coming  away  until  after  the  employment  of  a 
second  dose  of  the  drug. 

Naturally  one  would  have  supposed  a  complete 
cure  to  have  been  effected,  especially  since  there 
were  no  fragments  of  a  second  tapeworm  detected 
at  the  time.  However,  veiy  shortly  afterwards — I 
think  about  five  weeks — the  "  segments "  reap- 
peared, but  as  the  patient  now  considered  himself 
competent  to  undertake  his  own  case,  I  do  not  know 
what  result  followed  a  repetition  of  the  course  of 
treatment  I  had  previously  pursued.  It  was  quite 
clear,  however,  that  at  least  two  parasites  were 
originally  present,  one  of  them  having  successfully 
resisted  the  poisonous  effects  of  the  drug.  I  have 
no  doubt  a  foot  or  more  of  the  second  worm  had 
been  dislodged  with  the  first.  Had  there  been  a 
larger  proportion  of  the  second  parasite,  it  is  not 
probable  that  it  would  have  escaped  my  notice. 

In  all  ordinary  cases,  where  it  is  possible,  a  dili- 
gent search  should  be  made  for  the  head  of  the 
worm,  otherwise  it  is  impossible  to  clear  your 
patient's  mind  as  to  the  likelihood  or  otherwise 
of  a  return  of  the  disease.  Though  in  many  cases 


TAPEWORMS.  29 

I  have  effected  cures  without  these  necessary  exa- 
minations of  the  faeces,  yet  such  cases  are  not  alto- 
gether satisfactory. 

CASE  XIV. — P.  P.  For  this  respectable  person, 
•who  resided  at  Cheltenham,  I  was  induced,  under 
peculiar  circumstances,  to  prescribe,  although  I 
could  ascertain  results  only  through  those  who  re- 
quested my  professional  aid.  During  a  period  of 
several  years  she  had,  I  understood,  been  treated 
unsuccessfully,  taking  at  times  large  doses  of  tur- 
pentine which  had  acted  violently.  In  this  case  I 
prescribed  three-quarters  of  a  drachm  of  the  ethe- 
real extract,  combined  with  abundance  of  mucilage, 
&c.  This  treatment  effectually  dislodged  the  para- 
site. As  there  has  been  no  return  of  the  disease, 
it  is  quite  certain  that  the  head  passed  either  at  the 
first  or  second  movement  of  the  bowels.  This 
unhappy  patient  had  suffered  severely  from  ner- 
vousness, and  was  now  gradually  losing  her  sight. 
The  cure  in  this  case  not  only  saved  her  vision, 
but  also  her  life,  which  was  jeopardized  by  her 
rapidly  declining  general  health  and  consequent 
emaciation. 

CASE  XV. — M.  M.  R.,  a  captain  in  the  Royal 
Artillery,  consulted  me  in  January,  1866.  He 
states  that  he  has  suffered  for  six  years  from  tape- 
worm. Though  previously  robust,  he  has  been 
gradually  losing  strength  and  flesh,  being  at  the 
time  above  mentioned  extremely  debilitated.  Faint- 


80  LECTURES. 

ness,  vertigo,  occasional  difficulty  in  "  keeping  the 
saddle/'  and  consequent  depression  of  spirits,  are 
some  of  the  more  important  symptoms.  As  hap- 
pened in  several  of  the  foregoing  cases,  this  patient 
had  taken  kousso  and  other  remedies  without  success. 
My  first  administration  in  this  obstinate  case  only 
dislodged  a  few  feet  of  the  worm,  but,  after  allowing 
the  creature  to  redevelop  itself,  I  treated  the  "  host" 
again,  bringing  away  a  well-nourished  specimen  of 
the  beef-tapeworm  measuring  about  ten  feet  in 
length.  In  this  instance  the  head  was  not  found 
at  the  time ;  but,  as  there  appears  to  have  been  no 
return  of  the  parasite,  the  head  probably  passed  at 
an  evacuation  subsequent  to  those  discharges  imme- 
diately resulting  from  the  employment  of  the  drug. 
This  patient  contracted  the  disease  in  India. 

The  next  case  is  in  some  respects  similar ;  and  in 
all  probability  was  attended  with  an  entirely  satis- 
factory result : — 

CASE  XVI. — S.  A.,  a  gentleman  from  Peru, 
South  America,  has  been  infested  by  tapeworm  for 
several  years,  having  taken  the  usual  remedies 
without  success.  Consulting  me  (in  February, 
1869),  he  complains  chiefly  of  nausea,  frequent 
gnawing  pains  at  the  pit  of  the  stomach,  rendering 
him  at  times  almost  hypochondriacal.  He  appears 
to  have  contracted  the  disease  in  England,  before 
going  abroad.  Here,  again,  pursuing  the  male-fern 
method,  I  brought  away,  at  the  second  dose,  a 


TAPEWORMS.  31 

nearly  perfect  example  of  the  beef-tapeworm  mea- 
suring nine  feet  in  length.  The  neck  segments,  up 
to  within  some  three  or  four  inches  of  the  head, 
had  come  away  separately.  In  this  instance  I  did 
not  obtain  the  head,  but  I  have  little  doubt  that 
the  cure  was  complete.  In  the  hope  of  dislodging 
the  head  separately,  I  prevailed  upon  this  patient 
to  take  a  third  prescription,  which,  curiously 
enough,  brought  away  a  solitary  specimen  of 
the  so-called  common  whip  worm  (Tricocephalus 
dispar) . 

The  following  is  another  remarkable  case  in 
which  a  cure  was  effected  ;  the  head  of  the  worm 
having  certainly  passed  during  the  only  motion 
which  was  allowed  to  escape  my  examination  and 
scrutiny :—  / 

CASE  XVII. — L.  A.  J.,  a  married  lady  residing 
in  Kent,  consulted  me  in  May,  1869.  She  has 
for  nine  years  been  troubled  by  a  tapeworm,  which 
has  hitherto  resisted  the  usual  remedies ;  male-fern 
itself  being  included  in  the  long  list  of  drugs  taken. 
Among  the  more  prominent  symptoms  are  spas- 
modic pains  across  the  abdomen,  nausea,  sickness, 
and  loss  of  appetite.  Here,  although  the  doses  of 
male-fern  given  by  me  were  unusually  large,  six  or 
eight  separate  administrations  were  necessary,  the 
parasite  (Taenia  mediocanellata)  being  only  brought 
away  piecemeal. 

This  is  one  of  the  most  obstinate  cases   I   ever 


32  LECTURES. 

encountered,  as  the  worm  for  a  time  successfully 
resisted  the  most  vigorous  treatment.  However, 
this  patient's  great  courage  at  length  enabled  me 
by  perseverance  to  accomplish  the  desired  end.  She 
is  now  perfectly  free  of  the  parasite. 

CASE  XVIII. — Y.  Y.,  a  gentleman  residing  in 
Dublin,  requested  me  to  advise  and  prescribe  for 
him  (July,  1866),  although  I  should  have  no  oppor- 
tunity of  personally  ascertaining  by  inspection  the 
results  of  my  treatment.  He  had  suffered  from 
tapeworm  for  two  or  more  years.  The  male-fern 
preparations  which  he  procured  with  my  sanction 
in  Dublin  apparently  produced  little  or  no  effect ; 
but  the  medicines  (made  up  from  the  same  pre- 
scriptions) which  I  subsequently  instructed  a 
London  druggist  to  send  him,  were  most  effica- 
cious. It  seems  that  the  whole  parasite  came 
away  at  the  first  dose ;  at  all  events,  there  has 
been  no  return  of  the  disease.  This  patient  ap- 
peared considerably  astonished,  and  was  certainly 
gratified  by  the  result.  / 

CASE  XIX.— B.  C.  C.,  a  lady  residing  at  the 
west  end  of  London,  had  contracted  tapeworm  at 
Poonah,  in  India,  and  had  been  passing  segments 
continually  during  the  last  six  months.  She  con- 
sulted me  in  January,  1868,  when  I  found  that 
her  general  health  had  suffered  considerably,  and 
though  of  stout  build,  she  was  remarkably  anaemic. 
The  male-fern  method  of  treatment  brought  away 


TAPEWORMS.  33 

a  well  developed  beef  tapeworm,  upwards  of  ten 
feet  in  length.  The  head  was  not  found  at  the 
time,  and  had  probably  been  unintentionally  re- 
moved from  the  stool  contents  with  other  matters. 
In  this  case  also  the  cure  was  complete,  for  there 
has  certainly  been  no  return  of  the  disease,  and 
the  patient  is  in  the  enjoyment  of  perfect 
health. 


LECTURE  VI. 

Four  Successful  Cases  (XX.  to  XXIII.)  in  which  the  Head  of  the 
Tapeworm  was  expelled  and  found — Possibility  of  dislodging 
and  finding  the  Head  when  nothing  else  is  left  to  operate  on — 
The  Head  of  a  Bird's  Tapeworm  obtained  under  still  greater 
Difficulties—  Supposed  Case  (XXIV.)  of  the  Broad  Tapeworm 
or  Bothriocephalus  latu* — Case  XXV.,  illustrating  the  apparent 
Superiority  of  Male-fern  over  Areca  Nut  in  the  Treatment  of 
Tapeworm. 

GENTLEMEN, — Before  concluding  this  section  of  my 
subject  I  have  still  a  few  more  cases  to  bring  under 
your  notice,  several  of  them  being  of  remarkable 
interest.  / 

CASE  XX. — B.  D.,  a  gentleman  from  the  neigh- 
bourhood of  Manchester,  consulted  me  in  the 
month  of  December,  1865.  For  a  period  of  eighteen 
months  he  had  been  more  or  less  troubled  with 
fainting  fits,  accompanied  by  much  general  depres- 
sion. The  frequent  passage  of  "  joints"  occasioned 
him  great  annoyance  and  disgust.  He  has  been  treated 
for  tapeworm  hitherto  without  success.  After  some 
slight  preliminary  treatment,  I  ordered  him  a  male- 
fern  mixture  followed  by  a  cathartic.  One  dose 
sufficed  in  this  case  to  bring  away  a  perfect  Tania 
mediocanellata  with  the  head  and  neck  attached. 


TAPEWORMS.  35 

In  reference  to  this  case  I  may  remark  that  we 
have  here  an  instance  where  the  powdered  male- 
fern  had  been  employed  ineffectually  whilst  the 
extract  succeeded.  In  my  small  treatise  on  "  Tape- 
worms and  Threadworms"  I  have  figured  at  page  33 
the  head  of  the  tapeworm  removed  from  this 
patient.  It  not  only  showed  the  so-called  fifth 
sucker  very  distinctly,  but  also,  as  you  see  by  these 
more  highly  magnified  drawings,  the  vessels  of  the 
water-vascular  system. 

CASE  XXI. — C.  F.,  a  lady  residing  at  the  east 
end  of  London,  consulted  me  respecting  a  tapeworm 
which  had  annoyed  her  for  more  than  a  twelve- 
month, and  for  which  she  had  undergone  some 
useless  treatment.  The  only  symptoms  at  the  time 
(December,  1866)  were  occasional  nausea,  lassitude, 
and  loss  of  appetite.  In  this  case  also,  with  some 
preliminary  steps,  I  advised  and  prescribed  the 
male-fern  method.  Here  again  a  single  exhibition  of 
the  drug  brought  away  a  very  fine  specimen  of  the 
Ttenia  mediocandlata,  the  head  of  the  parasite  being 
dislodged  at  the  same  time,  though  separately. 

CASE  XXII. — S.  S.,  a  marrieti  lady  from  Roches- 
ter, sought  my  advice  and  placed  herself  under  my 
care  in  June,  1867.  Her  case  was  one  of  the  severe 
kind,  for  throughout  a  period  little  short  of  a  year 
she  had  been  repeatedly  subject  to  attacks  of  partial 
hemiplegia,  accompanied  by  involuntary  contrac- 
tions of  the  muscles  of  the  left  cheek.  She  was 
D  2 


36  LECTURES. 

clso  subject  to  spectral  illusions ;  all  the  symptoms 
being  attributed  to  the  presence  of  a  tapeworm. 
Here,  again,  perfect  success  followed  the  employment 
of  the  male-fern  remedy,  which  brought  away  a 
Tcenia  mediocanellata  fourteen  feet  in  length ;  the 
head,  which  was  unusually  well  supplied  with  black 
pigment  granules,  being  detached  separately.  Before 
this  patient  left  London  all  the  nervous  symptoms 
had  entirely  disappeared. 

CASE  XXIII. — H.  II.  J.j  a  gentleman  residing  in 
the  neighbourhood  of  Newcastle,  had  been  treated 
for  tapeworm  homoeopathically,  without  success. 
The  parasite  had,  I  understood,  been  contracted 
several  years  previously,  during  which  period  he  had 
simply  experienced  a  very  gradual  though  sensible 
loss  of  health.  In  the  treatment  of  this  case  I  had 
another  very  obstinate  parasite  to  deal  with  ;  repeated 
and  powerful  doses  of  male-fern  bringing  away 
separately,  large  portions  of  the  worm,  in  all 
amounting  to  about  twelve  feet.  With  the  fifth 
or  final  dose  I  succeeded  not  only  in  dislodging  the 
isolated  head,  but  in  detecting  its  presence  in  the 
evacuations  after  a  prolonged  search. 

In  reference  to  this  case,  which  I  think  can  only 
be  characterized  as  a  truly  remarkable  success, 
permit  me  to  say  that  no  person  unfamiliar  with  the 
appearances  presented  by  the  so-called  heads  of  taenia 
\could  possibly  have  discovered  the  head.  Altogether 
I  must  have  spent  five  or  six  hours  in  conducting  the 


TAPEWORMS.  37 

necessary  examinations  for  the  purpose,  and  was  ulti- 
mately regarded  by  securing  this  extremely  minute 
body  under  circumstances  of  the  utmost  difficulty. 
To  arrive  at  this  result  it  was  necessary  to  examine 
several  quarts  of  fsecal  matter  ounce  by  ounce ;  the 
object  sought  being  itself  smaller  than  the  head  of 
a  pin,  and  readily  mistakeable  for  other  foreign 
bodies  liable  to  occur  in  the  discoloured  mucus  and 
faeces.  In  this  case,  however,  I  was  encouraged  to 
persevere  by  the  recollection  of  a  previous  ex- 
perience, under  even  much  greater  difficulties. 
This  occurred  to  me  during  my  investigations  of 
entozoa  in  the  bodies  of  animals  dying  at  the 
Zoological  Society's  Menagerie,  Regent's  Park.  The 
instance  is,  I  think,  worth  recording  separately. 
On  January  16,  1858,  I  observed  some  partially 
disintegrated  proglottides  in  the  lower  part  of  the 
intestine  of  a  horned  pheasant.  These  were  the 
remains  of  a  small  tapeworm,  evidently  a  solitary 
specimen  (Ttenia  infandibuliformis}.  Being  anxious 
to  secure  the  head,  which  was  far  too  small  to  be 
rendered  visible  to  the  naked  eye,  I  subjected  the 
entire  contents  of  the  alimentary  canal  to  micro- 
scopic examination,  drop  by  drop,  and  at  length, 
after  a  tedious  investigation,  discovered  the  isolated 
head,  measuring  considerably  less  than  the  one- 
hundredth  of  an  inch  in  diameter.  Such  an  unex- 
pected success  as  this  has  naturally  given  me  great 
confidence  in  my  searches  after  the  heads  of  human 


38  LECTURES. 

tsenise  passed  during  the  employment  of  remedies ; 
and  I  may  even  venture  to  affirm  that  if,  in  all  the 
cases  of  the  beef  tapeworm  coming  under  my  care, 
I  could  have  obtained  the  same  facilities  for  ex- 
amination that  I  secured  in  the  last  mentioned  case 
of  human  tapeworm,  I  almost  doubt  if  the  "  head" 
would  in  any  instance  have  escaped  my  detection. 
As  it  is  I  have  no  reason  to  believe  that  any  case 
coming  fully  under  my  care  in  private  practice  has 
been  treated  unsuccessfully.  Cases  indeed,  not  here 
recorded,  have  come  before  me  where  I  have  had  no 
opportunity  of  giving  more  than  a  word  of  preliminary 
advice ;  whilst  in  others,  proper  advice  having  been 
given,  I  have  had  no  opportunity  of  ascertaining  re- 
sults. Instances  of  the  former  kind  are  particularly 
tantalizing,  especially  when  you  have  reason  to  be- 
lieve that  you  would  have  to  deal  with  a  compara- 
tively rare  form  of  parasite.  For  example  : — 

CASE  XXIV. — P.  H.,  a  lady  residing  in  the 
western  suburbs  of  London,  comes  to  consult  me 
respecting  a  tapeworm,  which  she  appears  to  have 
contracted  some  years  since  whilst  resident  in 
Germany.  When  I  saw  her  (November,  1867)  she 
was  not  passing  tapeworm .  segments  or  joints  of 
the  ordinary  kind;  but  occasionally  an  entire  foot 
or  more  of  the  body  (strobile)  came  away  with  the 
ordinary  movement  of  the  bowels.  I  at  once 
diagnosed  the  presence  of  a  broad  tapeworm,  my 
suspicions  being  confirmed  by  the  notions  of  the 


TAPEWORMS.  39 

patient  herself,  who,  on  being  shown  a  figure  of 
Bothriocephalus  latus,  at  once  declared  that  the 
portion  referred  to  exactly  corresponded  with  the 
drawing  I  exhibited.  Here,  as  my  opinion  only 
was  sought,  I  had  no  opportunity  of  trying  the 
effects  either  of  male-fern  or  of  any  other  remedy. 

The  above  happens  to  be  the  only  case  where 
this  particular  aberrant  type  of  tapeworm  has  come 
before  me  in  actual  practice ;  nevertheless  I  need 
hardly  say  that  I  have  examined  and  dissected  many 
specimens  of  the  worm  procured  from  other  sources. 
One  of  the  examples  thus  obtained  had  been  ex- 
pelled from  an  Irish  girl  by  a  dose  of  male-fern  ; 
and  I  entertain  very  little  doubt,  from  the  observa- 
tions of  Leuckart,  Weinland,  Kuchenmeister,  and 
others,  that  the  ordinary  treatment  pursued  in  cases 
of  tsenia  will  equally  well  suffice  for  those  of 
bothriocephalus.  A  case  recently  presented  itself 
at  St.  Bartholomew's  Hospital,  and  was  successfully 
treated,  as  I  understood,  by  the  male-fern  method. 
To  quote  one  excellent  Continental  authority,  I  may 
refer  you  to  Dr.  Weinland,  who  has  remarked  in 
his  " Essay  on  the  Tapeworms  of  Man"  that  the 
remedies  against  this  worm  are  the  same  as  those 
employed  in  cases  of  Tcenia  solium ;  and  he  might 
have  added,  as  well  as  against  all  other  forms  of 
cestodes,  liable  to  infest  the  human  body  in  their 
adult  state. 

You  will  not  have  forgotten,  perhaps,  that  when 


40  LECTURKS. 

in  a  previous  discourse  I  was  enumerating  the 
various  tapeworm  remedies,  I  alluded  to  Dr.  John 
Barclay's  recorded  experiences  with  betel-nut. 
Unquestionably,  it  is  possessed  of  true  vermifuge 
properties,  especially  if  administered  in  the  form  of 
powder.  Why  it  is  not  admitted  into  the  British 
Pharmacopoeia  I  am  at  a  loss  to  understand ;  unless 
it  be  that  its  efficiency  is  recognised  as  inferior  to 
that  of  the  many  excellent  remedies  already  in 
vogue.  There  may  be  some  prejudice  against  the 
employment  of  a  drug  so  frequently  given  by 
veterinarians  to  dogs  ;  and  it  is  not  a  little  re- 
markable that  comparatively  small  doses  suffice  to 
expel  these  parasites  from  the  canine  "bearers/' 
Here  is  a  case  in  which  I  recently  used  the 
powdered  areca  or  betel  nut  in  combination  with 
small  doses  of  scammony.  I  should  tell  you  that  the 
male-fern  extract  had  been  unsuccessfully  employed 
in  this  case  previously,  but  not  by  myself. 

CASE  XXV. — A.  H.,  a  young  lady  from  Bucking- 
hamshire, aged  thirteen,  first  sought  my  advice  in  the 
autumn  of  last  year  (October  21,  1869).  It  appears 
that  scarcely  four  months  had  elapsed  since  the 
presence  of  tapeworm  had  been  placed  beyond  a 
doubt.  For  the  cure  of  the  disorder  she  had  taken 
three  separate  doses  of  male-fern,  about  a  month 
previous  to  the  time  at  which  I  first  saw  her.  Un- 
fortunately the  "  oil"  had  been  administered  in 
unusually  small  doses,  and  consequently  there  was 


TAPEWORMS.  41 

little  chance  of  procuring  an  entirely  satisfactory 
result.    However,  the  patient's  friends  brought  me 


no  less  than  nine  separate  fragments  of  Tania 
mediocanellata ;  and  these  collectively  measured 
rather  more  than  the  same  number  of  feet  in 
length.  Finding  her  general  health  to  have  suf- 
fered considerably,  I  ordered  a  tonic  and  altera- 
tives, at  the  same  time  forbidding  the  re- employ- 
ment of  vermifuges  for  the  present.  At  the  expira- 
tion of  three  weeks  there  was  a  very  decided  im- 
provement ;  but  towards  the  close  of  the  year  her 
health  began  to  fail  again,  and  tapeworm  segments 
reappeared  in  the  stools.  Coming  to  town  to  be 
finally  placed  under  my  care  early  in  the  present 
year,  I  found  her  in  a  weakly  state,  but  not  too  low 
to  undergo  treatment.  After  a  brief  interval,  I 
ordered  three  drachms  of  the  powdered  areca  nut, 
which,  though  combined  with  a  few  grains  of 
scammony,  required  to  be  followed  by  the  exhibition 
of  a  brisk  saline  cathartic.  These  active  agents 
eventually  dislodged  four  feet  of  a  remarkably 
broad  tapeworm ;  but  I  was  dissatisfied  with  the 
exceedingly  tedious  manner  in  which  this  still  living 
moiety  of  the  parasite  had  come  away.  Repeating 
the  areca  nut  without  further  effect,  I  returned  to 
my  favourite  remedy,  and,  with  an  efficiently  pre- 
scribed dose  of  male-fern,  followed  by  a  powerful 
purgative,  dislodged  the  remainder  of  the  parasite 
quite  dead.  The  head  was  found. 


42  LECTURES. 

Here  you  see  the  superiority  of  a  true  worm- 
poison  over  a  drug  which  is  probably  only  obnoxious 
to  the  animal.  Not  only  was  the  helminth  dis- 
lodged with  the  head  intact,  but  it  was  effectually 
killed,  and  in  this  instance  the  final  moiety  came 
away  without  the  patient's  being  aware  of  the  fact 
of  its  escape.  The  case  is  of  further  practical  inte- 
rest as  showing  the  impropriety  of  timidly  giving 
only  ten  minim  doses,  when  larger  quantities  of 
the  extract  can  be  borne  with  impunity.  It  con- 
firms the  statements  I  have  repeatedly  made  to  you 
respecting  the  time  to  be  allowed  for  the  full  de- 
velopment of  the  parasite  ;  it  also  shows  the  expe- 
diency of  employing  the  right  remedy  at  the  right 
time,  and  it  demonstrates  the  advantage  you  may 
possess  in  knowing  precisely  the  diagnostic  cha- 
racters of  the  parasite  you  have  to  deal  with.  A 
haphazard  method  of  treatment  may  occasionally 
succeed ;  but  the  more  you  know  of  the  surround- 
ings of  any  form  of  helminthiasis,  the  more  will  you 
deserve  the  confidence  reposed  in  you. 


LECTURE  VII. 

Tapeworm  Disorders  rarely  or  never  Incurable — Medical  Skill  occa- 
sionally baffled  for  a  Time — Mistakes  made  from  Carelessness 
in  Diagnosis — No  Excuse  for  such  Errors — Remarkable  Case 
(XXVI.)  in  which  a  Lady  was  for  Six  Years  treated  for  Tape- 
worm when  no  Parasite  existed — Inferences  and  Suggestions 
arising  from  the  Consideration  of  the  Facts  of  this  Case — Final 
Reflections. 

I  BELIEVE  the  cases  already  brought  forward  fairly 
illustrate  the  amount  of  success  which  you  may 
legitimately  expect  when  in  future  you  are  dealing 
with  these  disorders ;  but  I  would  not  conceal  from 
you  the  fact  that  you  may  occasionally  encounter 
instances  where  your  skill  may  be  baffled.  I  do 
not  mean  to  say  that  any  case  of  tapeworm  can  be 
called  incurable ;  but  it  sometimes  happens  that  a 
patient  loses  the  necessary  courage  to  continue 
treatment  after  a  few  unsuccessful  trials  of  the 
most  reputed  drugs.  At  the  worst,  we  need  only 
pronounce  them  to  be  obstinate,  but  certainly  not 
incurable. 

Easy  of  attainment  as  the  necessary  amount  of 
practical  knowledge  on  this  subject  at  first  sight 
appears,  I  can  assure  you  that  I  have  seen  some 


44  LECTURES. 

very  unfortunate  results  following  advice  given  and 
based  upon  an  incorrect  or  hasty  diagnosis.  I  do 
not  now  speak  of  those  instances  where  one  has 
to  deal  with  patients  who,  having  been  properly 
treated  for  tapeworm,  are  still  assured  that  they 
are  yet  playing  the  part  of  host  whilst  no  parasite 
exists ;  but  I  refer  to  cases  where  the  patients  have 
been  placed  under  treatment  for  tapeworm,  where 
no  such  worm  or  any  other  similar  parasite  ever 
had  any  existence  in  the  alimentary  canal  of  such 
persons.  You,  with  the  knowledge  you  have  al- 
ready acquired  in  hospital  and  dispensary  practice, 
may  perhaps  be  inclined  to  smile  at  the  bare  possi- 
bility of  such  mistakes  being  made;  nevertheless 
it  is  with  stubborn  facts,  resting  upon  personal  ex- 
perience, that  I  have  to  deal,  and  it  is  to  their 
teachings  that  I  would  urgently  invite  your  atten- 
tion. Perhaps  the  most  remarkable  instance  which 
has  come  under  my  observation  is  the  following : — 
CASB  XXVI. — G.  A.,  a  middle-aged  lady,  and 
the  wife  of  an  officer  residing  in  India,  sought  my 
advice  on  the  9th  of  March,  1871.  She  informed 
me  that  she  had  been  suffering  from  the  presence 
of  tapeworm  throughout  the  past  six  years,  and 
for  this  disorder  she  had  been  treated  by  several 
medical  gentlemen.  That  their  treatment  had  been 
vigorous  may  be  gathered  from  the  fact  that  she 
had  taken  kousso,  male-fern,  turpentine,  and,  I 
believe,  other  remedies.  She  further  assured  me 


TAPEWORMS.  45 

that  she  was  still  in  the  habit  of  passing  portions  of 
the  worm  to  the  extent  of  several  feet  in  length, 
whilst  neither  herself  nor  her  professional  advisers, 
past  and  present,  entertain  or  have  ever  enter- 
tained the  smallest  doubt  as  to  the  presence  of 
tapeworm. 

Now,  gentlemen,  with  such  evidence  as  that 
before  you,  would  you  not  at  once  have  been  in- 
clined to  proceed  to  business,  and  to  treat  the  case 
for  tapeworm  accordingly  ?  Probably  you  would, 
especially  if  you  were  in  active  general  practice, 
and  had  little  time  to  deliberate.  Fortunately  I 
was  in  a  position  to  give  the  case  the  fullest  con- 
sideration; but  from  the  very  first  indications 
offered  I  arrived  at  the  conclusion  that  the  notion 
of  the  presence  of  tapeworm  was  altogether  a  delu- 
sion. Her  symptoms  presented  nothing  remark- 
able. It  is  true,  indeed,  that  she  complained  of 
constitutional  debility,  faintness,  and  general  ner- 
vousness, with  the  occasional  accompaniment  of  a 
peculiar  choking  sensation ;  but  some  of  these 
symptoms  had  been  observed  and  treated  before 
the  presumed  true  nature  of  the  case  was  pointed 
out  by  her  advisers.  On  account  of  some  of  these 
symptoms,  and  quite  apart  from  the  question  of 
tapeworm,  she  had  consulted,  amongst  others,  Sir 
Thomas  Watson. 

If  you  ask  the  cause  of  my  doubts  as  to  the 
presence  of  tapeworm,  I  have  in  the  first  place  to 


46  LECTURES. 

remark,  that  very  careful  questionings  on  my  part 
elicited  the  fact  that  no  separate  and  isolated  pro- 
glottides  were  actually  escaping  with  the  fa;ces  at 
the  time.  This  led  me  to  explain  to  the  patient  that, 
if  no  joints  had  passed  previously,  the  portions  of  the 
tapeworm  alleged  to  have  come  away  so  frequently 
could  not  possibly  be  those  of  an  ordinary  tape- 
worm ;  but  they  might  be  referred  to  the  common 
species  of  Bothriocephalus  which  is  sometimes  called 
the  Broad  Tapeworm.  Not,  however,  believing  for 
a  moment  that  she  was  infested  by  any  kind  of 
cestode  parasite,  I  was  compelled  to  place  my 
opinion  in  direct  opposition  to  those  of  my  profes- 
sional brethren  who  had  treated  her  for  tapeworm. 

This  negative  advice  not  appearing  to  give  satis- 
faction— in  point  of  fact,  I  was  provisionally  looked 
upon  as  an  ignoramus — I  consented  to  treat  the 
case  as  if  it  were  one  of  Bothriocephalus,  as 
indeed  it  was  just  possible  it  might  have  been. 
Thus,  I  ordered  a  male-fern  emulsion,  followed  by 
a  brisk  cathartic  ;  and  these  drugs,  the  administra- 
tion of  which  was  several  times  repeated,  acted 
very  efficiently.  Now,  had  there  been  any  tape- 
worm present,  we  should  undoubtedly  have  obtained 
the  necessary  evidence  of  its  presence.  But  what 
was  the  immediate  professional  result  of  my  treat- 
ment ?  Naturally  enough,  it  excited  the  suspicion 
which  apparent  ill-success  always  begets.  Whilst, 
on  the  one  hand,  I  maintained  more  firmly  than 


TAPEWORMS.  47 

ever  that  the  statements  of  her  previous  advisers 
were  incorrect,  the  patient,  on  the  other  hand,  and 
also  a  friend  who  accompanied  her,  attributed  the 
negative  results  to  my  imperfect  mode  of  treatment! 
Determined  not  to  be  put  down  by  the  customary 
and  stupid  assurances  that  older  men  than  myself 
(including  one  especially  distinguished  gentleman) 
had  asserted  that  the  tapeworm  was  certainly  pre- 
sent, I  sought,  in  the  next  place,  to  impart  con- 
fidence to  my  patient  by  producing  a  variety  of 
specimens  of  Ttsniae  and  Bothriocephali,  requesting 
her  to  say  which  entozoon  the  alleged  parasite  most 
resembled.  I  must  tell  you  that  she  was  in  the 
habit  of  passing  portions  of  this  wonderful  worm 
either  weekly  or  fortnightly,  and  it  always  came 
away  more  or  less  copiously  after  medical  treat- 
ment. Well,  having  explained  the  general  struc- 
ture of  the  specimens  produced,  I  succeeded  in 
making  a  somewhat  more  favourable  impression  on 
her,  mind,  and  she  was  obliged  to  admit  that  none 
of  the  specimens  exhibited  precisely  resembled  the 
particular  parasite  from  which  she  was  suffering. 
Still  she  could  not  doubt  that  her  previous  ad- 
visers were  correct  in  their  opinions.  "  They  had 
actually  seen  the  creature,  and  must  know  all  about 
it ;  but  I  had  not  seen  it,  and  therefore  could 
not  know  what  it  was."  That  was  her  mode  of 
reasoning.  What  was  to  be  done  ?  My  obstinacy 
appeared  mere  impertinence ;  besides,  my  medicines 


48  LECTURES. 

Lad  done  no  good,  and  they  had  brought  nothing 
away.  At  length  it  was  happily  remarked,  that  as 
she  contemplated  remaining  in  London  two  or 
three  days  longer,  perhaps  in  the  interval  a  portion 
of  the  creature  might  make  its  appearance,  and  in 
this  event  an  opportunity  would  be  afforded  me  of 
pronouncing  upon  the  true  nature  of  the  entozoon 
and  of  advising  as  to  further  treatment.  Fortu- 
nately, on  the  morning  of  the  sixth  day  succeeding 
that  on  which  my  opinion  was  first  sought,  frag- 
ments of  the  said  parasite  duly  appeared.  You 
may  imagine  that  I  lost  no  time  in  making  the 
necessary  stool- examination,  when,  sure  enough,  in 
place  of  any  tapeworm,  I  found  several  long  rolls 
of  exudation-membrane,  portions  of  them  being 
considerably  more  than  a  foot  in  length.  Thus 
the  whole  mystery  was  cleared  up.  The  rolls  were 
tolerably  uniform  in  thickness,  and  sufficiently 
tenacious  to  admit  of  their  being  held  up  between 
the  blades  of  a  pair  of  forceps.  As,  however,  their 
appearance  was  semi-transparent,  almost  gelatinous, 
devoid  of  jointing,  and  marked  by  oblique  Hues  of 
twisting,  it  was  clear  that  the  coils  in  question 
offered  no  fair  grounds  for  the  persistently  asserted 
opinion  that  this  lady  was  suffering  from  tapeworm. 
Proceeding  therefore  to  explain  to  my  patient  the 
pseud-helminthic  character  of  the  creature  she  had 
passed,  she  had  the  satisfaction  of  learning  and  be- 
lieving that  for  some  six  years  past  she  had  been 


TAPEWORMS.  49 

uselessly,  not  to  say  injuriously,  drugged,  her 
medical  advisers  honestly  believing  all  the  while 
that  they  would  thus  expel  a  tapeworm,  which,  as 
you  see,  never  had  any  existence  excepting  within 
the  precincts  of  their  own  vivid  imaginations. 

Once  more  I  ask  you  to  reflect  on  the  facts  of 
this  case.  They  are  few  and  simple.  Here  is  a 
lady  seriously  out  of  health.  She  endures  various 
personal  hardships,  leaves  her  husband,  spends  her 
money,  and  takes  several  disagreeable  medicines  for 
no  other  reason  than  to  get  rid  of  a  parasite  which 
she  certainly  never  possessed.  Of  course  it  is  anK  I 
unpleasant  thing  to  have  to  give  an  opinion  adverse  ( 
to  that  of  one's  professional  brethren ;  but  this  is 
only  one  instance  amongst  many  where  we  are/ 
called  upon  to  display  a  little  moral  courage  in  thej 
interests  of  truth  and  of  our  patients'  welfare.! 
There  is  not  a  well-informed  and  experienced 
member  of  the  profession  who  has  not,  at  some 
time  or  other,  been  placed  in  a  similar  predicament 
as  regards  other  maladies;  and  in  respect  of  para- 
sitism, all  I  contend  is  that  in  order  to  prevent 
the  recurrence  of  such  frightful  mistakes  it  is 
desirable  that  you  should  familiarize  yourselves 
with  the  appearances  presented  by  the  various  kinds 
of  human  entozoa. 


LECTURE   VIII. 

Obstinate  Cases  will  occasionally  occur  in  Practice — Case  XXVII. 
-Instances  of  the  Value  of  Kousso  —  Cases  XXVIII. 
and  XXIX. — Large  Doses  of  Male-fern  may  give  rise  to 
Symptoms  of  Jaundice — Rapidity  of  the  Growth  of  Tapeworms 
shown  by  the  Fact  that  in  the  last-named  Case  upwards  of 
Sixty  Feet  of  Tapeworm  were  developed  from  a  Single  Head 
within  Eleven  Months. 

GENTLEMEN, — Before  completing  this  part  of  the 
course  I  shall  have  occasion  to  lay  before  you  some 
other  instances  of  supposed  tapeworm  where  none 
existed  ;  but  in  the  meantime  let  me  bring  before 
you  one  or  two  of  the  obstinate  cases  previously 
referred  to.  My  object  is  not  to  pretend  that  no 
such  cases  could  occur  under  the  methods  of  treat- 
ment I  employ,  but  rather  to  illustrate  the  certainty 
of  their  occasional  occurrence. 

CASE  XXVII. — J.  T.,  a  resident  at  Battersea, 
about  sixty  years  of  age,  first  saw  me  on  the  12th  of 
December,  1870.  He  had  been  previously  treated 
with  partial  success  both  as  a  private  and  hospital 
patient.  He  had  a  remarkably  spare,  not  to  say 
emaciated  and  gloomy  look;  and  this  was  partly 
due,  in  my  judgment,  to  the  fact  of  his  being  a 


TAPEWORMS.  51 

rigorous  total  abstainer.  He  complained  of  great 
languor,  accompanied  by  pricking  and  other  myste- 
rious pains  within  the  abdomen ;  but  beyond  this, 
and  a  tone  of  natural  despondency,  there  was  little 
else  worthy  of  notice.  At  first  I  treated  him  with 
male-fern,  both  in  the  form  of  powder  and  extract, 
bringing  away  a  few  feet  only  of  the  worm.  At 
the  expiration  of  a  month  I  administered  active 
doses  of  areca  nut  and  scammony ;  but  this  proved 
less  effective  than  the  male-fern  remedies.  In  the 
next  place  I  employed  kousso,  which  brought  away 
the  entire  body  of  the  worm,  excepting  the  head 
and  neck.  Lastly,  at  the  expiration  of  nine  weeks, 
as  the  parasite  again  had  returned,  or  rather  had 
grown  to  its  ordinary  length,  I  repeated  the  kousso. 
This  second  trial  of  the  Abyssinian  remedy  proving 
just  as  effective  as  the  first,  by  dislodging  another 
ten  feet  of  this  truly  obstinate  beef  tapeworm. 

In  regard  to  this  case  it  was  certainly  not 
unnatural  that  the  patient  should  grow  despondent 
and  think  his  case  incurable;  yet  the  comparative 
success  of  the  kousso,  as  contrasted  with  that  of 
other  drugs,  should  have  induced  him  to  give  it  yet 
a  third  trial.  As  a  rule  I  deem  kousso  far  less 
powerful  than  male-fern,  yet  in  special  instances  one 
finds  particular  remedies  asserting  their  apparent 
superiority  in  this  marked  manner.  Possibly  there 
may  be  physiological  conditions,  apart  from  the 
therapeutic  action  of  the  drug,  which  may  account 
E  2 


52  LECTURES. 

for  this  exceptional  activity  in  certain  cases.  Here 
are  other  instances. 

CASE  XXVIII. — D.  W.,  a  gentlerrfan  residing  in 
the  east  of  London,  has  suffered  from  tapeworm  for 
rather  more  than  a  twelvemonth.  He  has  taken  the 
usual  remedies  without  any  success;  and  this  was 
the  more  remarkable  since  the  proglottides  which  I 
examined  proved  to  be  those  of  the  beef  tapeworm. 
I  commenced  treating  the  case  on  the  18th  of 
August,  1870,  ordering  a  male-fern  emulsion, 
aperient  pills,  and  a  cathartic  mixture.  Almost  no 
result  following  the  first  trial  I  advised  a  repetition 
of  the  remedies,  which  again  proved  ineffective.  In 
the  second  place  I  resorted  to  the  areca-mit  method, 
followed  by  vigorous  doses  of  castor-oil;  nevertheless 
only  some  score  of  isolated  proglottides  came  away. 
Guided  by  the  above-mentioned  and  other  experiences 
I  was  in  the  next  instance  prepared  to  show  that 
kousso  might  again  assert  its  apparent  superiority 
over  the  other  remedies ;  but  he  grew  disheartened, 
and  refused  to  persevere  with  the  necessary  treat- 
ment, under  which  it  is  by  no  means  improbable 
the  parasite  would  have  succumbed,  at  least  to  the 
remarkable  extent  noticed  in  the  previous  case. 

CASE  XXIX. — G.  J.  M.,  a  member  of  Parliament, 
first  consulted  me  on  the  12th  of  September,  1870. 
For  some  ten  or  eleven  years  he  has  played  the  un- 
enviable part  of  host  to  a  most  obstinate  tapeworm. 
He  is  under  the  impression  that  he  contracted  the 


TAPEWORMS.  53 

disorder  in  Norway ;  and  he  has  been  professionally 
treated  for  it  at  St.  Petersburg  without  any 
success  whatever.  The  remedies  employed  were 
kousso,  male-fern,  and  turpentine.  Beyond  the 
inconvenience  of  carrying  the  creature  about  with 
him  he  has  suffered  little  or  nothing,  though  com- 
plaining occasionally  of  giddiness.  Being  a  remark- 
ably powerful  man  I  resolved  upon  adopting  the 
mosfc  active  treatment,  and  I  had  the  satisfaction  of 
bringing  away  no  less  than  fourteen  feet  of  a  well 
nourished  beef  tapeworm  by  the  first  administration 
of  the  male-fern  extract.  Ten  weeks  subsequently 
the  parasite  returned,  when  a  similar  course  of 
treatment  was  again  advised.  This  was  in  February, 
1871.  On  this  second  occasion  we  succeeded  in 
dislodging  no  less  than  sixteen  feet  of  the  tape- 
worm ;  nevertheless  the  head  remained  behind. 
At  the  expiration  of  another  nine  weeks  the  parasite 
returned  for  the  third  time ;  and  on  this  occasion  I 
resolved  to  try  the  areca-nut  method.  This  drug, 
like  the  previous  preparations  of  male-fern,  acted 
most  efficiently  •>  and  this  time  the  parasite  dis- 
lodged measured  no  less  than  seventeen  feet  in 
length.  Here,  however,  it  may  be  remarked  that 
the  body  of  the  worm  came  away  alive,  whereas 
under  the  male-fern  poison  it  was  always  dead  at 
the  time  of  expulsion.  On  yet  another  occasion 
this  unusually  fine  cestode  returned,  when,  for  the 
fourth  time,  I  sought  to  expel  it.  This  was  in 


54  LECTURES. 

July,  1871.  Naturally  anxious  to  overcome  its 
obstinacy  I  this  time  employed  doses  made  up  from 
a  recently  prepared  extract  of  male-fern,  knowing 
by  previous  experiences  the  great  value  of  fresh 
drugs.  This  medicine,  prepared  by  Messrs.  Allen 
and  Hanbury,  acted  even  more  rapidly  and  effec- 
tively than  any  of  those  I  had  previously  ad- 
ministered; nevertheless  we  had  again  to  content 
ourselves  with  the  expelled  and  dead  body  of  a 
tapeworm,  to  the  extent  of  another  seventeen  feet 
in  length,  including  nearly  all  the  neck  without  the 
head. 

This  case  is  certainly  instructive,  and  within  my 
own  experience,  in  some  respects  unique.  You  will 
please  to  observe  that  all  the  remedies  were  good 
and  effective.  In  every  instance  the  parasite  was 
dislodged,  leaving  only  its  head  and  a  small  portion 
of  the  neck  behind.  Its  growth  was  remarkably 
rapid,  attaining  its  mature  size  in  a  comparatively 
short  interval  of  time.  There  was  no  lack  of 
courage  on  the  part  of  the  patient,  whilst  the 
previous  treatment  abroad  had  been  utterly  inade- 
quate. In  the  probable  event  of  its  returning  for 
a  fifth  time  there  remain,  of  course,  other  drugs  to 
be  tried.  But  here,  again,  (with  much  more  apparent 
reason  than  the  last  case  afforded,)  the  patient 
despaired  of  success,  and  gave  me  to  understand 
that  no  further  treatment  would  be  submitted  to. 
Be  this  as  it  may,  I  should  certainly  look  for  even- 


TAPEWORMS.  55 

tual  success  if  the  patient  changed  his  mind. 
Whatever  treatment  happens  to  be  adopted,  it 
is  impossible  that  the  authelmintics  employed 
should  act  more  vigorously  than  these  have  done. 
The  doses  were  as  large  as  could  be  given  with 
safety ;  so  strong  were  they,  indeed,  that  in  the 
case  of  the  male-fern  there  was  a  decided  action 
upon  the  liver.  The  flow  of  bile  was  for  a  short 
time  checked,  and  there  were  decided  premoni- 
tory symptoms  of  jaundice.  These  physiological 
indications,  however,  very  soon  passed  off,  leaving 
no  prejudicial  effects  behind  them.  This  is  the 
only  instance  in  which  I  have  noticed  any  special 
action  on  the  liver ;  and  it  is  sufficiently  accounted 
for  by  the  fact  that  I  employed  unusually  active 
treatment.  I  felt  justified  in  pursuing  this  course 
on  account  of  the  utterly  negative  results  obtained 
by  the  treatment  the  patient  had  undergone  when 
living  abroad. 

In  a  short  while  I  hope  to  be  able  to  complete 
what  I  have  further  to  say  on  this  subject.  We 
shall  then  pass  on  to  the  consideration  of  the 
general  structure,  development,  and  best  modes  of 
treating  the  threadworms  and  their  allies. 


LECTURE    IX. 

Comparative  Rarity  of  Obstinate  Cases — Reasons  for  not  attempting 
to  operate  on  the  Head  of  Worm  when  left  behind — Cases  XXX. 
and  XXXI. — The  best  Time  to  administer  Remedies  for  Tape- 
worm— Why  Caution  in  this  Respect  is  so  very  necessary — Case 
XXXII. — Advantage  of  having  to  treat  Patients  who  are  edu- 
cated— Case  XXXIII. — Circumstances  under  which  Treatment 
should  be  delayed. 

GENTLEMEN, — It  is  not  often  that  you  will  en- 
counter such  cases  as  the  example  last  quoted ;  yet 
should  you  do  so,  by  all  means  assure  your  patient 
that  his  case  will  eventually  prove  amenable  to 
treatment.  Oftentimes,  as  I  have  before  remarked, 
the  head  of  the  worm,  though  not  expelled  at  the 
time,  is  discharged  separately,  some  time,  it  may 
be,  after  actual  treatment ;  and  in  Case  XXIII.,  to 
which  I  incidentally  alluded,  you  have  an  instance 
of  its  expulsion  therapeutically,  when  there  was 
nothing  else  to  operate  upon.  I  would  not,  how- 
ever, as  a  rule  advise,  as  some  have  done,  the  repe- 
tition of  anthelmintics  immediately  after  you  have 
succeeded  in  expelling  the  body  of  the  parasite,  for 
if  your  remedies  have  exerted  a  poisonous  effect  to 
the  extent  just  mentioned,  the  return  of  the  para- 


TAPEWORMS.  57 

site  is  exceptional.  Here  are  two  additional  in- 
stances, the  second  of  which  may  very  well  be 
relegated  to  the  class  of  obstinate  cases,  whilst  the 
first  was  probably  a  complete  cure : — 

CASE  XXX. — E.  C.,  a  tall,  spare,  middle-aged 
lady,  from  New  York,  United  States,  consulted  me 
on  the  28th  of  June,  1870.  In  this  case  evidence 
of  the  existence  of  tapeworm  had  only  been  ob- 
served about  six  months  previously ;  yet,  to  use  her 
own  words,  within  that  comparatively  short  space 
of  time  she  had  "  rapidly  lost  flesh."  Greatly  dis- 
gusted at  her  condition  as  a  parasite-bearer,  she 
displayed  the  utmost  anxiety  to  get  rid  of  the 
animal.  Accordingly,  I  prescribed  a  male-fern 
emulsion  and  an  active  cathartic  to  follow.  This 
treatment  expelled  eight  feet  of  a  beef  tapeworm 
on  the  29th,  whilst  a  repetition  of  the  drugs  se- 
cured the  evacuation  of  no  less  than  nine  feet  more 
of  the  parasite  on  the  30th  of  the  same  month. 
In  addition  to  these  two  moieties  of  the  body, 
properly  so  called,  the  neck  of  the  worm  was  like- 
wise separately  expelled  in  fragments.  Altogether 
this  tapeworm  measured  fully  nineteen  feet,  and 
considering  the  activity  of  the  parasiticide,  it  was 
most  unlikely  that  the  head  should  have  survived 
its  poisonous  action.  I  discouraged  the  notion  that 
any  further  treatment  was  likely  to  be  necessary, 
and  this  lady,  after  a  short  interval,  left  for  Paris, 
where  (not  apprehending  the  siege)  she  intended  to 


58  LECTURES. 

stay  for  several  months.  I  may  also  mention  that 
she  willingly  assented  to  my  proposal  that  she 
should  again  see  me  on  her  return  from  the  Con- 
tinent if  the  parasitic  enemy  reappeared. 

CASE  XXXI. — L.  D.,  a  lady-like  young  person, 
sought  my  advice  in  the  early  part  of  May,  1870. 
She  came  from  Staffordshire,  and  stated  that  she 
had  been  the  victim  of  a  tapeworm  for  some  three 
years  past.  In  view  of  a  cure,  she  had  been  very 
properly  advised  to  try  male-fern,  kousso,  and  other 
parasiticides.  No  very  marked  success  had  at- 
tended this  kind  of  treatment;  nevertheless  she 
admitted  that  she  had  parted  with  a  portion  of  her 
"  guest,"  to  the  extent  of  perhaps  six  feet,  only 
three  weeks  previously.  As  she  could  not  wait 
the  requisite  time  necessary  for  the  full  re-develop- 
ment of  the  parasite,  I  prescribed  for  her  at  once, 
though  somewhat  unwillingly.  With  far  more 
success,  under  these  circumstances,  than  I  antici- 
pated, the  male-fern  method  brought  away,  after 
the  first  dose,  the  body  of  the  creature,  whilst  a 
second  administration  sufficed  to  dislodge  all  that 
remained  of  the  parasite  except  its  head.  Alto- 
gether the  fragments  of  the  finely  attenuated  neck 
and  the  body  included  measured  twelve  feet,  so  that 
the  animal — allowing  some  eighteen  inches  for  the 
growth  accomplished  during  the  interval  which  had 
elapsed  since  her  previous  treatment — could  not 
have  been  less  than  seventeen  feet.  In  this  case  I 


TAPEWORMS.  59 

departed  from  my  general  rule,  and  advised  a  third 
dose,  in  the  hope  of  dislodging  the  isolated  head, 
but  without  avail.  At  the  expiration  of  three 
months  the  proglottides  reappeared,  and  in  the 
following  September  she  was  again  under  my  care. 
On  this  occasion  I  prescribed  the  areca-nut  powders, 
followed  by  brisk  salines,  when,  for  the  second  time, 
almost  the  entire  creature  was  effectually  dislodged. 
In  about  three  months  more  the  parasite  reap- 
peared for  the  third  time,  when  I  advised  by  letter 
a  repetition  of  the  areca-nut  method.  In  this 
instance,  therefore,  I  had  unfortunately  no  oppor- 
tunity of  ascertaining  the  results,  as  the  patient 
was  either  unwilling  or  unable  to  visit  the  metro- 
polis again.  No  doubt,  as  too  many  under  like 
circumstances  are  apt  to  do,  she  began  to  despair 
of  ultimate  success ;  yet  there  was  nothing  in  her 
case  which  need  have  led  her  to  such  a  conclusion. 

If  you  have  followed  me  in  this  and  certain 
other  cases  you  may  have  noticed  the  reluctance 
with  which  I  have,  in  a  few  instances,  recommended 
immediate  treatment.  I  am  quite  aware  that  in 
doing  so  I  am  departing  from  the  ordinary  practice 
pursued  by  others ;  but  I  have  the  strongest  reasons 
for  such  a  course.  As  a  rule  it  may  be  said  that 
the  more  you  have  to  operate  on,  the  more  likely 
are  you  to  be  successful.  Obviously  therefore 
when  a  patient  presents  himself  who  has  only 
shortly  before  got  rid  of  a  portion  of  the  tapeworm, 


60  LECTURES. 

it  would  be  unwise  to  administer  drugs  which  have 
no  chance  of  giving  thorough  evidence  of  their 
efficacy.  Even  though  you  should  explain  the 
position  of  the  case  very  fully,  the  patient,  espe- 
cially if  he  or  she  be  deficient  in  education,  is 
apt  to  become  altogether  dissatisfied.  Here  is  an 
instance : — 

CASE  XXXII. — W.  L.,  about  nineteen  years  of 
age,  the  son  of  a  butcher  residing  in  a  small  town 
in  the  county  of  Norfolk,  came  with  his  father  to 
consult  me  on  the  18th  of  June,  1870.  He  had 
been  under  treatment  for  tapeworm  less  than  a 
fortnight  previously;  but  he  was  still  anxious  for 
further  advice.  That  he  had  been  skilfully  treated 
by  his  ordinary  medical  adviser  was  evident  from 
the  alleged  fact  that  the  medicines  last  taken  had 
brought  away  a  tapeworm  fully  thirty  feet  in 
length.  It  was  asserted,  moreover,  that  the  head 
had  not  been  found.  Making  due  allowance  for 
the  very  probable  exaggeration  of  the  youth's  state- 
ment, I  was  at  some  pains  to  explain  the  unlikeli- 
hood of  there  being  anything  left  behind ;  but  I 
consented  (certainly  unwisely)  to  prescribe  a  male- 
fern  mixture,  for  the  chance  of  detaching  the  head 
and  neck,  in  case  they  might,  as  seemed  probable, 
have  remained  behind.  When  it  was  afterwards 
found  that  only  a  negative  result  followed  this 
treatment,  both  parent  and  son  appeared  to  be 
greatly  annoyed,  and  thus,  in  spite  of  my  explana- 


TAPEWORMS.  OL 

tions,  it  was  quite  likely  that  they  looked  for  the 
elimination  of  an  additional  thirty  feet  of  tape- 
worm, including  the  head. 

When  you  have  to  deal  with  persons  on  whose 
good  sense  you  may  confidently  rely,  experiences  of 
this  kind  will  not  occur;  but  the  impatience  of 
some  individuals  to  realize  what  they  term  "  prac- 
tical results  "  prevents  their  appreciation  of  advice 
and  treatment  which  is  not  immediately  operative. 
I  will  give  one  instance,  amongst  many,  where  I 
have  advised  delay  with  a  satisfactory  termination 
of  the  case. 

CASE  XXXIII. — C.  M.,  an  Oxford  graduate, 
about  thirty  years  of  age,  consulted  me  on  the 
3rd  of  April,  1869.  He  had  recently  been  treated 
for  tapeworm  with  a  considerable  amount  of  success, 
but  felt  quite  sure  that  he  still  entertained  the  para- 
site. Not  that  he  had  any  ocular  evidence  of  the 
fact  from  the  passage  of  proglottides ;  but  that 
he  still  experienced  persistent  sleeplessness  and 
general  debility,  frequently  amounting  to  exhaus- 
tion. These  symptoms  he  could  only  account  for 
on  the  supposition  that  the  tapeworm  was  still 
present.  From  the  statements  advanced  respecting 
the  amount  of  tapeworm  dislodged  by  previous 
treatment,  I  conjectured  that  in  the  event  of  its 
being  still  attached  it  would  require  about  five 
weeks  more  in  order  to  arrive  at  maturity.  On 
this  account  I  advised  delay.  At  the  expiration  of 


62  LECTURES. 

one  month  he  wrote  to  the  effect  that  the  pro- 
glottides  had  reappeared,  and  thus  my  suspicions 
proved  to  be  correct.  In  the  following  June  he 
returned  to  town,  and  placed  himself  under  my 
immediate  care,  when  accordingly  I  adopted  the 
male-fern  method  of  treatment.  The  first  two 
administrations  produced  no  result,  but  on  doubling 
the  dose  of  the  extract  and  increasing  its  action  by 
cathartics  and  plenty  of  coffee,  the  desired  effect 
was  accomplished.  The  parasite  measured  sixteen 
feet  in  length. 

This  case  is  particularly  instructive,  as  showing 
the  correctness  of  the  diagnosis,  the  propriety  of 
delaying  to  give  anthelmintics,  and  the  possibility 
of  the  parasites  resisting  one  drachm  doses  of  the 
ethereal  extract  of  male-fern.  Though  the  head  of 
the  entozoon  was  not  found  at  the  time,  it  pro- 
bably came  away  with  a  subsequent  movement  of 
the  bowels.  If  it  had  returned  I  should  have  been 
informed  in  view  of  a  repetition  of  treatment.  It 
is  not  often,  however,  that  you  will  find  patients 
occupying  a  lower  sphere  of  life  who  will  accept 
with  good  grace  this  kind  of  advice;  but  our 
endeavour  should  be  to  do  the  best  we  can  for 
them,  notwithstanding  that  they  are  utterly  dis- 
satisfied with  our  opinion.  The  late  Professor  Syme, 
of  Edinburgh,  once  told  me  of  a  patient  who  came 
to  him  with  the  intention  of  having  his  leg  cut  off; 
and  on  being  informed  by  that  distinguished 


TAPEWORMS.  63 

surgeon  that  amputation  was  quite  unnecessary, 
and  that  there  was  nothing  seriously  the  matter 
with  his  knee-joint,  he  resisted  the  notion  of  paying 
any  fee  for  such  disappointing  advice  !  Thus  it 
happens  sometimes  that  the  very  best  advice  is 
treated  with  indifference  or  even  contempt;  whereas, 
if  incorrect  advice  be  given,  involving  either  loss  of 
limb  or  risk  of  life  to  the  patient,  the  adverse 
opinion  is  accepted  with  gratitude. 


LECTURE    X. 


Patients  are  commonly  only  pleased  with  Advice  which  is  in  entire 
Harmony  with  their  Preconceived  Ideas — Cases  XXXIV. 
and  XXXV.— Parsimonious  Reluctance  of  Wealthy  People  to 
obtain  Medical  Advice— Case  XXXVL,  il'ustrating  the  Im- 
portance of  a  Correct  Opinion — Different  Species  of  Eutozoa  are 
sometimes  associated  together — Case  XXXVII. 


GENTLEMEN, — The  following  is  a  characteristic 
instance  in  which  I  thought  it  my  duty  to  resist 
the  wishes  of  a  parent  that  active  treatment  should 
be  pursued : — 

CASE  XXXIV. — H.  C.,  a  lad  thirteen  years  of 
age,  called  with  his  father  to  see  me  on  the  7th  of 
May,  1870.  For  fully  three  years  he  has  been 
troubled  with  tapeworm.  As  he  was  fond  of  under- 
done beef,  and  only  rarely  partook  of  pork,  it  was 
easy  to  conjecture  the  true  character  of  the  parasite. 
He  had  taken  kousso  very  frequently;  its  action 
usually  causing  the  expulsion  of  short  fragments  only. 
However,  some  three  weeks  back,  he  passed  as 
much  as  twelve  feet  of  the  worm  at  a  single  sitting; 
yet  he  was  desirous  of  being  treated  afresh.  Of 
course  I  resisted  the  pressure  in  this  instance;  and 


TAPEWORMS.  65 

the  more  so  as  lie  was  suffering  from  an  attack  of 
chorea,  which  first  appeared  during  the  previous 
summer.  Advising  the  parent  to  dismiss  from  his 
mind  the  notion  of  tapeworm,  I  strongly  insisted 
that,  for  the  present  at  least,  the  administration  of 
vermifuges  was  entirely  contra-indicated.  I  pre- 
scribed tonics,  and  an  immediate  change  of  scene, 
with  temporary  cessation  from  school  or  other 
work;  but,  from  what  I  have  already  advanced, 
it  will  scarcely  surprise  you  to  learn  that  my 
advice  was  received  with  marked  tokens  of  dis- 
satisfaction. To  have  given  powerful  anthelmiutics 
would,  in  my  judgment,  have  been  cruel  and 
useless:  yet  such  advice,  if  tendered,  would 
not  only  have  harmonized  with,  the  preconceived 
opinions  of  the  parent,  but  would  also  have  secured 
his  entire  confidence  accordingly. 

CASE  XXXV. — S.  L.  J.,  a  captain  in  her  Ma- 
jesty's Indian  army,  called  upon  me  in  the  spring 
of  1870.  He  was  under  the  impression  that  he  was 
still  infested  by  a  tapeworm,  for  which  disorder  he 
had  been  treated  some  three  years  previously,  whilst 
he  was  under  the  depressing  effects  of  an  attack  of 
jungle  fever.  On  questioning  him  as  to  the  passage 
of  proglottides  I  arrived  at  the  conclusion  that  he 
had  already  been  effectually  cured ;  so  far,  at  least, 
as  the  mere  expulsion  of  the  parasite  was  concerned. 
This  view  of  his  case,  however,  was  received  by 
himself  with  considerable  reluctance ;  and  therefore, 

F 


66  ,   LECTURES. 

in  accordance  with  his  wishes,  I  prescribed  an 
anthelmintic  in  the  form  of  powders,  containing 
areca-nut  and  scammony.  As  I  had  fully  antici- 
pated, and  explained  as  probable,  the  results  were 
entirely  negative;  the  patient  in  this  particular 
instance  having  the  good  sense  to  rest  satisfied  with 
the  evidence  thus  afforded  of  his  complete  freedom 
from  tapeworm. 

As  I  have  elsewhere  remarked,  these  suspected 
instances  of  tapeworm  are  by  no  means  uncommon, 
and  it  is  in  this  sort  of  cases  that  so  much  mischief 
accrues  from  the  parsimonious  reluctance  of  even 
comparatively  wealthy  persons  to  obtain  a  definite 
opinion.  On  the  other  hand,  many  persons  go 
about  with  parasites  in  their  interior,  gradually 
losing  health  without  a  suspicion  as  to  the  real 
cause  of  their  ailments.  Here  is  another  case  of 
supposed  tapeworm  where  a  final  opinion  proved  of 
the  utmost  service  : —  j 

CASE  XXXVI. — R.  M.,  a  middle-aged  gentleman, 
residing  in  the  northern  suburbs  of  London,  sought 
my  advice  on  the  1st  of  May,  1871.  He  had  been 
infested  by  tapeworm  for  about  a  twelvemonth, 
during  which  he  had  been  extremely  nervous  and 
depressed ;  whilst  from  his  very  agitated  manner  it 
was  very  easy  to  perceive  that  the  evil  effects  of  the 
parasitism  had  not  yet  disappeared.  On  closely 
questioning  him,  I  found  that  nearly  eleven  weeks 
had  clasped  since  he  was  last  treated  for  the 


TAPEWORMS.  67 

malady ;  and  lie  admitted  that  the  male-fern  treat- 
ment then  employed  was  successful  to  the  extent  of 
bringing  away  from  ten  to  fifteen  feet  of  the  worm. 
However,  he  quite  believed  that  the  animal  had 
grown  afresh,  and  was  prepared  to  take  any  vermi- 
fuge I  might  order.  This  kind  of  treatment  I 
decidedly  refused  to  adopt,  exhorting  him  mean- 
while to  dismiss  from  his  mind  the  notion  of  his 
still  being  a  parasite  bearer.  I  gave  advice  as  to 
diet,  and  ordered  a  powerful  neurotonic.  .  At  the 
expiration  of  twenty-four  days  he  returned  much 
improved  in  his  general  health,  and  he  appeared 
much  gratified  when  I  now  tendered  him  the  most 
positive  assurances  as  to  his  entire  immunity  from 
tapeworm  or  any  other  evil  being  of  a  similar 
description. 

Of  course  it  is  not  always  safe  to  say  that  a 
patient  is  free  from  parasites  when  the  particular 
entozoon  for  which  he  has  been  treated  happens  to 
be  absent ;  but  with  very  careful  questioning  you 
may  generally  form  a  correct  diagnosis  on  this 
point.  Occasionally  in  treating  for  one  kind  of 
worm  you  encounter  another  of  a  totally  different 
description.  Thus  in  Case  XVI.  I  expelled  a 
Trichocephalus ;  and  the  whip  worm,  you  know,  is 
comparatively  rare  in  this  country.  It  is  so 
at  least  in  the  human  subject,  but  not  in  our 
food-producing  animals.  As  regards  other  para- 
sites liable  to  occur  in  association  with  tape- 


68  LECTURES. 

worms,  it  is  always  worth  while  ascertaining  the 
presence  or  absence  of  threadworm  in  any  case 
that  may  present  itself  for  treatment.  Here  is  an 
instance  in  which  I  prescribed  for  the  two  kinds  of 
entozoa : — 

CASE  XXXVII.— B.  V.  H.,  about  thirty-five  years 
of  age,  an  officer  in  her  Majesty's  Hidian  army, 
sought  my  advice  on  the  13th  of  May,  1871.  He 
has  been  infested  by  tapeworm  for  a  period  of  ten 
months.  He  is  quite  sure  that  he  contracted  the 
disorder  in  the  Punjaub,  where  measly  beef  is 
unusually  prevalent.  He  has  been  treated  with 
kousso  and  male-fern ;  but  with  such  feeble  results 
that  hitherto  only  a  few  inches  of  the  worm 
have  come  away.  Proglottides,  nevertheless,  are 
passed  daily.  His  general  health  is  good;  but 
he  is  sometimes  troubled  with  slight  hemicrania, 
vertigo,  and  singing  noises  in  the  head.  At 
once  adopting  the  male -fern  method  I  expelled  a 
very  fine  specimen  of  the  beef-tapeworm,  measuring 
fifteen  feet  in  length,  including  the  finest  neck- 
segments  close  up  to  the  head.  Observing  a  solitary 
threadworm  in  the  faeces  I  advised  some  further 
treatment  in  view  of  ascertaining  whether  any 
more  were  left  behind.  I  administered  areca-nut 
powder  and  santonin,  followed  by  a  brisk  saline 
purgative ;  but  this  combination  was  adopted  not 
alone  for  the  purpose  of  testing  for  oxyurides, 
seeing  that  the  head  of  the  tapeworm  might  still 


TAPEWORMS.  69 

have  remained  attached.  Two  or  three  more 
threadworms  having  thus  been  expelled,  I  further 
recommended  the  employment  of  sulphur  and  saline 
mineral  waters,  the  efficiency  of  which  I  have 
found  so  marked  in  more  serious  cases  of  this 
description.  There,  however,  appeared  to  be  no 
more  oxyurides. 


LECTURE  XL 

The  Age  at  which  Tapeworm  most  commonly  Occurs — Case 
XXXVIII. — Tapeworm  may  Attack  very  Young  Persons — 
Case  XXXIX.— Parasitism  may  be  masked  by,  or  compli- 
cated with,  various  other  Diseases — Cases  XL.  and  XLI. — 
The  Cucumerine  Tapeworm  of  the  Dog  has  been  found  in 
Man — Necessity  for  Caution  in  identifying  the  Species — Op- 
posed Genital  Pores  in  the  Proglottides  not  Conclusive — Case 
XLIL—  Remarkable  Cestode  Abnormality. 

GENTLEMEN, — In  regard  to  the  age  at  which  tape- 
worm most  frequently  occurs  in  the  human  bearer, 
my  experience  has  been  decidedly  in  favour,  so  to 
speak,  of  middle-aged  persons ;  or  say,  rather,  be- 
tween twenty  and  forty  years.  This  is  sufficiently 
accounted  for  by  the  more  strongly  pronounced 
meat-eating  habits  of  persons  at  this  period  of  life, 
in  association  with  their  frequent  penchant  for 
underdone  flesh.  As  people  get  into  years,  soups, 
fish,  and  made  up  dishes,  which  are  tender  and 
readily  masticated,  become  more  and  more  appre- 
ciated ;  whilst  as  regards  the  Indian  peninsula,  so 
productive  of  tapeworm,  the  older  men  will  have 
returned  home  to  enjoy  the  flesh  of  our  native 
beeves,  which  at  present  remain  tolerably  free  from 


TAPEWORMS.  71 

cestode  parasites.  How  long  they  may  remain  so  is 
quite  another  question.  Young  children,  when  they 
become  infested,  do  not  suffer  so  much  from 
tapeworm  as  from  either  oxyurides  or  lumbrici; 
but  they  ought  not,  on  that  account,  to  be  allowed 
to  go  about  year  by  year  as  tapeworm  bearers. 
I  mention  this  for  reasons  quite  apart  from  the 
possibly  injurious  effects  ultimately  accruing  to 
themselves.  The  following  case  is  one  of  the  kind 
alluded  to : — 

CASE  XXXVIJL— C.  B.,  from  Brighton,  is  a 
young  gentleman  only  six  years  of  age  ;  neverthe- 
less, during  fully  one-half  of  this  short  period  of 
his  life,  reckoning  up  to  the  24th  of  April  1871,  he 
has  enjoyed  the  unenviable  privilege  of  playing  the 
part  of  host  to  a  tapeworm.  At  least,  I  was  so  in- 
formed by  the  lady  who  brought  him  to  receive  my 
opinion.  It  is  true,  there  were  no  particular  symp- 
toms likely  to  produce  alarm  on  his  behalf;  yet 
there  was  the  customary  loss  of  tone,  excessive 
pallor,  feeble  pulse,  and  indifferent  appetite.  Al- 
though there  was  no  chance  of  my  watching  the 
results  of  any  treatment  I  might  propose,  I  consi- 
dered it  my  duty  to  prescribe  an  anthelmintic.  I 
ordered  areca-nut  powders  in  two  drachm  doses,  to 
be  repeated,  with  an  aperient,  every  two  hours  until 
its  action  had  proved  effective.  These  produced  no 
immediate  result,  but  towards  the  end  of  the  fol- 
lowing month  he  passed  the  tapeworm,  which  I  was 


72  LECTURES. 

told  measured  four  yards  in  length.  He  has  since 
had  no  return  of  the  disorder. 

In  cases  of  threadworm  and  round  worm  it  is  not 
uncommon  to  meet  with  instances  of  infection  in 
children  much  younger  than  C.  B.,  speaking  from  the 
time  when  he  was  first  attacked ;  and  here  I  may 
mention  that  the  case  in  which  I  originally  deter- 
mined the  certainty  of  the  occurrence  otdscaris  mys- 
tax  in  the  human  body  was  that  of  an  infant  only 
thirteen  months  of  age,  as  you  will  find  recorded  in 
the  pages  of  the  Lancet  for  January  10th,  18G3. 
The  youngest  age  at  which  I  have  known  tapeworm 
to  occur  is  given  in  the  following  instance : — 

CASE  XXXIX. — M.  D.,  a  member  of  the  pro* 
fession,  called  on  me  in  the  spring  of  1871,  re- 
questing a  second  opinion  as  to  the  course  to  be 
pursued  in  the  case  of  a  female  child  only  eighteen 
months  of  age.  Afflicted  with  tapeworm,  she  had, 
under  his  able  treatment,  passed  no  less  than  four 
yards  of  the  parasite ;  but  as  the  head  was  not  de- 
tected at  the  time,  he  had  some  hesitation  as  to 
further  prescribing.  Guided  by  previous  experi- 
ences, I  naturally  counselled  delay ;  suggesting  the 
employment  of  areca-nut  powders  in  the  event  of 
any  return.  What  happened  I  do  not  know ;  but 
the  interesting  point  of  the  case  lies  in  the  circum- 
stance that  it  was  known  to  the  parents  that  the 
child  had  first  partaken  of  underdone  meat  just 
four  months  previously ;  so  that  it  was  quite  clear 


TAPEWORMS.  73 

that  its  earliest  efforts  as  a  flesh-feeder,  at  the  age 
of  fourteen  months,  had  unluckily  secured  for  it  the 
privilege  of  becoming  a  parasite-bearer.  In  this 
respect,  therefore,  the  case  is  singularly  instructive, 
if  not  altogether  unique. 

Once  more  permit  me  to  insist  upon  the  desi- 
rability of  exercising  great  caution,  not  only  in 
accepting  the  statements  of  others  concerning  the 
presence  of  tapeworm,  but  also  in  respect  of  the 
propriety  of  at  once  adopting  active  measures  of 
treatment.  Apart  from  the  actual  demonstration 
of  the  existence  of  any  parasite,  the  mere  symptoms 
themselves  are  very  likely  to  deceive.  We  should 
be  prepared  to  encounter  all  sorts  of  complications ; 
sometimes  looking  for  indications  of  previous  disor- 
ders, parasitic  or  otherwise,  as  the  case  may  be,  when 
the  patients  themselves  are  all  the  while  attributing 
their  ailments  to  an  ever-present  or  persistent  ento- 
zoon.  Some  of  the  cases  previously  advanced  will 
have  afforded  a  sufficient  illustration  of  my  meaning, 
but  in  this  particular  relation  I  will  select  two 
others,  each  of  them  presenting  features  more  or 
less  worthy  of  attention  : — 

CASE  XL. — H.  M.,  a  young  lady,  twenty-three 
years  of  age,  visited  me  on  the  1st  of  October,  1869, 
and  desired  that  I  would  treat  her  for  tapeworm, 
from  the  presence  of  which  she  believed  herself  to 
be  suffering.  Fortunately,  a  friend  who  accompanied 
her  had  brought  portions  of  the  alleged  parasite  in 


74  LECTURES. 

a  bottle  for  my  inspection  and  determination.  There- 
fore, on  questioning  the  patient  and  on  examining 
the  supposed  parasitic  debris,  I  had  no  difficulty  in 
at  once  deciding  that  this  patient  was  not  infested 
by  any  tapeworm.  However,  she  succeeded  in 
satisfying  me  that  she  had  really  suffered  from 
oxyurides  a  few  years  previously  ;  and  I  was  inclined 
to  look  upon  some  of  her  present  symptoms  as  a 
permanent  result  of  the  attack  by  her  former  ene- 
mies. At  all  events,  she  was  now  suffering  from 
acute  hysteria,  coupled  with  delusions.  There  were 
distinct  indications  of  "  globus,"  combined  with 
voracity,  and  a  tendency  to  bolt  her  food.  To  add 
to  these  vexatious  symptoms,  it  was  rendered  quite 
manifest  that  she  had  been  very  much  neglected  ; 
and  it  was  therefore  not  surprising  that  I  also  found 
evidence  of  serious  constitutional  disturbance,  in 
association  with  distressing  anaemia,  leucorrhcea, 
occasional  diarrhoea,  abdominal  distention,  a  feeling 
of  soreness  over  the  region  of  the  stomach,  and 
other  painful  complications.  I  prescribed  a  mixture 
containing  assaftetida  and  carbonate  of  ammonia; 
at  the  same  time  suggesting  certain  rules  as  to  diet 
and  occupation.  Obviously,  however,  it  was  a  case 
where  treatment  could  be  of  little  avail  in  the  ab- 
sence of  personal  kindness  and  consideration  on  the 
part  of  those  upon  whom  such  duties  naturally 
devolved.  / 

CASE  XLI. — A.  A.,  a  gentleman  residing  in  Liver- 


TAPEWORMS.  I  5 

pool,  requested  advice  on  the  19th  of  October  1870. 
He  had  been  the  victim  of  tapeworm  for  the  last 
four  years.  His  nervous  system  had  been  much 
injured,  rendering  the  movements  of  his  limbs  irre- 
gular and  uncertain.  He  was  still  subject  to  twitch- 
ings,  accompanied  with  tingling  sensations  at  the 
tips  of  the  fingers  ;  and  he  not  unfrequently  cut 
himself  whilst  in  the  act  of  shaving.  Under  the 
care  of  several  medical  advisers  he  had,  at  different 
times,  taken  male-fern,  kousso,  turpentine,  pumpkin- 
seeds,  and  other  remedies  ;  and  only  some  three 
weeks  previous  to  the  date  of  his  present  visit  he 
had  passed  a  tapeworm,  estimated  to  have  been  five 
yards  in  length.  Under  these  circumstances  I  pre- 
scribed a  tonic,  but  counselled  caution  and  delay  as 
to  the  employment  of  any  more  vermifuges,  deeming 
it  highly  probable  that  there  would  be  no  return  of 
the  parasite. 

I  have  an  especial  pleasure  in  recording  this  case 
because  (apart  from  any  actual  examination  of  the 
entozoon)  the  facts  that  were  at  the  time  brought 
under  my  notice  afforded  evidence  of  the  clearest 
possible  description  that  this  patient  had,  during 
the  invasion  of  an  ordinary  species  of  tapeworm, 
been  infested  by  the  so-called  cucumerine  tape- 
worm. The  explicit  statements  of  one  of  this 
gentleman's  professional  attendants  as  to  the  cha- 
racters presented  by  certain  small  tapeworms  which 
after  treatment  were  passed,  along  with  portions  of 


76  LECTURES. 

the  ordinary  species,  seemed  quite  conclusive.  The 
alleged  extremely  delicate  character  of  the  pro- 
glottides,  ascertained  to  have  been  furnished  with 
bilaterally  disposed  sexual  orifices,  two  to  each  seg- 
ment, could  only  have  referred  to  this  species  of 
cestode,  and  in  this  case  therefore  I  thought  I  saw 
a  fresh  confirmation  of  the  statements  originally 
and  independently  advanced  by  Leuckart  and 
Eschricht,  that  the  cucumerine  tapeworm  (whether 
you  call  it  Tcenia  canina,  T.  elliptica,  or  T.  cucu- 
merina,  it  perhaps  matters  little)  is  occasionally 
liable  to  infest  the  human  body. 

That  the  statements  of  others  in  respect  of  the 
specific  characters  presented  by  particular  forms  of 
human  Tania  cannot  always  be  relied  on  I  have 
already  shown,  and  in  this  connexion  few  seem  to 
bear  in  mind  the  very  remarkable  malformations 
which  occur  amongst  the  tapeworms.  In  this 
purely  professional  course  I  cannot  go  fully  into 
the  matter,  but  I  may  mention  that  only  very  re- 
cently I  had  a  case  of  Tcenia  solium  where  several 
of  the  proglottides  had  two  sexual  papillae  arranged 
precisely  as  in  the  cucumerine  tapeworm.  The  odd 
thing  is,  moreover,  that  this  patient  also  came  from 
Liverpool,  a  circumstance  which  naturally  seems  to 
weaken  the  verbal  evidence  produced  in  the  pre- 
vious instance  as  to  the  occurrence  of  Tcenia  elliptica 
in  the  human  subject.  The  facts  are  as  follow  I—- 
CASE XLII. — A.  H.,  a  respectable  married  person, 


TAPEWORMS.  77 

under  middle  age,  has  had  tapeworm  for  fully  two 
years.  She  admits  that  she  at  one  time  had  a  sort 
of  mania  for  underdone  meat,  especially  pork, 
which  she  frequently  ate  in  the  perfectly  raw  state. 
She  experiences  obscure  pains  about  the  abdomen, 
has  irritation  at  the  nasal  passages,  and  elsewhere, 
and  is  frequently  disturbed  at  night.  Her  ordinary 
medical  attendant  appears  to  have  treated  her  most 
judiciously,  and  his  success  has  been  so  marked 
that  on  one  occasion  it  was  estimated  that  the 
remedies  brought  away  no  less  than  seventy  feet  of 
tapeworm  in  fragments.  These  portions  were  referred 
to  two  or  more  individuals.  She  was  last  treated 
about  two  months  since,  on  which  occasion  twenty- 
four  more  feet  of  tapeworm  came  away,  all  being 
referred  to  a  single  worm,  as  it  included  the 
finest  neck  segments  close  up  to  the  head.  The 
drugs  employed  were  kamala  and  male-fern.  When 
she  brought  me  six  loose  proglottides  in  a  phial  I 
observed  that  two  of  the  segments  presented  the 
abnormal  characters  above  mentioned,  but  in  other 
respects  the  joints  corresponded  with  those  of  the 
pork-tapeworm.  Under  my  advice  she  first  took  a 
drachm  and  a  half  of  male-fern  extract  in  two 
successive  doses  without  effect.  She  then  took 
powders  containing  half-an-ounce  of  areca-nut  with 
a  drachm  of  the  fern-root,  which  dislodged  more 
than  eighteen  feet  of  tapeworm,  and  this  was  fol- 
lowed up  by  a  combination  of  these  two  drugs 


78  LECTURES. 

with  two  drachms  of  kamala,  which  she  stated  had 
expelled  the  rest  of  the  worm.  Unfortunately,  I 
was  deprived  of  the  opportunity  of  searching  for 
the  head,  but  the  final  portion  removed  and  re- 
tained for  my  examination  measured  upwards  of 
five  feet.  This  specimen  of  Tania  solium  therefore 
measured  fully  twenty-four  feet  in  length,  and  it 
displayed  a  great  number  of  malformed  joints,  not 
only  of  the  kind  already  described,  but  also  of  the 
type  more  commonly  seen  in  specimens  of  the  beef- 
tapeworm. 

These  cestode  abnormalities  exhibit  every  con- 
ceivable variation  of  character,  but  as  I  said  before, 
I  have  no  time  to  dwell  upon  them.  I  will  only, 
therefore,  further  mention  that  by  far  the  most  re- 
markable form  of  tapeworm  proglottid  which  I 
have  ever  seen  is  one  preserved  in  the  Royal  College 
of  Surgeons'  Museum.  It  is  a  Hunterian  specimen, 
marked  No.  120  in  the  revised  Catalogue  of  the 
Entozoological  Series.  This  strange  segment  displays 
no  less  than  twenty-two  separate  sexual  orifices ;  or, 
in  other  words,  we  have,  as  it  were,  twenty-two 
segments  rolled  into  one. 


LECTURE    XII. 

Prevalence  of  the  Seatworm  Disease—The  Children's  Pest — Wide 
distribution  of  Oxyuris  vermicularis — The  Eggs  and  their  con- 
tained Embryos — Development  of  the  Larvee — Opinions  of  Vix, 
Leuckart,  Zenker,  and  Heller^-Head-quarters  of  the  Adult 
Worm — Symptoms  produced  in  the  Human  Eearer. 

GENTLEMEN,— The  particular  parasitic  disorder,  or 
helminthiasis,  to  which  I  now  propose  to  call  your 
attention,  constitutes  one  of  the  most  prevalent  and 
obnoxious  maladies  with  which  we  have  to  deal. 
Five  out  of  every  six  persons  who  come  to  you 
stating  that  they  are  troubled  with  worms,  wish  you 
to  understand  that  they  are  infested  with  Ascarides 
or,  more  properly,  Oxyurides.  Some  persons  inno- 
cently suppose  that  there  are  but  two  kinds  of  human 
entozoa,  namely,  threadworms  and  tapeworms ;  and 
they  are  not  a  little  surprised  when  you  inform 
them  that  all  mankind  are  liable  to  be  invaded  by 
one  or  other  of  at  least  a  score  of  distinct  specific 
forms  of  helminth.  As  a  rule,  however,  it  is  better 
to  withhold  this  sort  of  information,  for  in  the  case 
of  nervous  and  apprehensive  persons  your  commu- 
nicativeness might  induce  serious  mischief. 


80  LECTURES. 

The  human  threadworms,  properly  so  called,  refer 
exclusively  to  the  species  termed  Oxyuris  vermicu- 
laris,  which  may  emphatically  be  called  the  children's 
pest.  Although  its  presence  within  the  human 
body  is  seldom  attended  with  fatal  results,  there  is 
no  entozoon  more  universally  distributed  amongst 
the  younger  members  of  our  race.  At  the  same 
time  it  is  an  entire  mistake  to  suppose  that  it  con- 
fines its  attacks  to  young  persons,  since  we  are  liable 
to  play  the  part  of  host  at  any  age.  Some  persons, 
indeed,  are  all  their  lifetime  subject  to  this  dis- 
agreeable form  of  helminthiasis. 

As  I  have  stated  in  the  second  edition  of  my 
smaller  treatise  (now  out  of  print),  the  existence  of 
oxyuris,  as  happens  also  with  some  other  entozoa,  is 
not  limited  to  either  hemisphere,  though  it  appears 
to  be  rather  more  abundant  in  warm  than  in  cold 
climates.  In  this  country  it  is  not  so  frequent  as 
on  the  Continent ;  nevertheless,  with  such  data  as 
have  been  placed  before  you  thus  far,  I  have  been 
led  to  hazard  the  statement,  that  probably  about 
one-tenth  of  our  island  population  are  actually 
infested  by  this  minute  worm.  Be  the  truth  of  that 
conjecture  proven  or  disproven,  as  the  case  may  be, 
by  subsequent  investigations,  it  is  more  consolatory 
to  be  able  to  affirm  that  of  those  who  are  thus 
called  upon  to  play  the  part  of  host  only  a  very  small 
proportion  really  suffer  serious  inconvenience. 

The   general  appearance  of  the  Oxyuris  vermi- 


THREADWORMS.  81 

cularis  is  so  well  known  to  most  of  you  that  I  need 
not  minutely  describe  it;  moreover  a  detailed  account 
,  of  the  anatomical  peculiarities  of  this  parasite  will  be 
(/T found  in  my  larger  work  on  Entozoa,with  explanatory 
figures.      If  an  ordinary  full-grown  female  worm  be 
submitted  to  microscopic  examination,  even  the  em- 
ployment of  the  one-inch  achromatic  objective  glass 
will   reveal  the  presence   of  a  multitude   of  eggs 
internally.      Under  higher  powers,  say  the  quarter 
inch,   the   contents   of  the   eggs   will  be   found   to 
display  every  variety  of  character,  according  to  the 
positions   which   they   severally  occupy  within  the 
uterine  tubes  of  the  maternal  body.    As  Claperede 
and   myself  long  ago  pointed  out,  and  quite  inde- 
pendently, the  most  advanced  eggs  do  not  exhibit 
vermiform  or  filiform   embryos  in  their  interior  (as 
Kuchenmeister    erroneously  figured  and    described 
t  n  them),    but    thick    bodied,    tadpole-shaped    larvae. 
*    i  After  extrusion  from  the  body  of  the  parent,  how- 
1  ever,    they  soon    assume  the  vermiform  character, 
•  that    is,  when    they  are    placed   under   conditions 
suitable  to  their  further  development. 

The  researches  of  Yix  and  Leuckart  have  shown 
that  "  one  needs  only  to  expose  the  eggs  to  the  action 
of  the  sun's  rays  in  a  moistened  paper  envelope,  when 
at  the  expiration  of  some  five  or  six  hours  the  tadpole- 
shaped  embryos  will  have  already  become  slender 
elongated  worms.  At  this  stage  they  are  not 
altogether  unlike  the  sexually  mature  oxyurides  in 


82  LECTURES. 

shape,  exhibiting  rather  lively  movements  under  the 
application  of  warmth/'  The  best  way  to  rear  the 
vermiform  stage  of  oxyuris  is  to  put  a  number  of 
the  eggs  in  a  glass  tube  filled  up  with  saliva.  The 
tube  should  then  be  placed  in  the  arm-pit,  in 
which  situation  it  can  be  carried  about  with  little 
inconvenience.  In  a  very  short  space  of  time 
the  transformations  will  commence,  and  go  on  con- 
tinuously until  the  vermiform  condition  is  attained. 
If  it  be  asked  whether  the  embryos,  whilst  still 
within  escaped  eggs  which  have  found  their  way 
into  the  human  bowel,  are  capable  of  arriving  at  this 
vermiform  stage  of  maturity,  the  answer  is  decidedly 
in  the  affirmative ;  for,  as  Leuckart  has  also  re- 
marked, "  the  elongated  embryos  are  to  be  found 
not  only  in  the  faeces,  but  also  in  the  mucus  of  the 
rectum  above  and  around  the  anus/'  I  believe  it 
was  further  stated  by  Vix  that  the  mature  or 
vermiform  embryos  were  occasionally  to  be  detected 
in  the  intestine  of  the  human  bearer  along  with  the 
eggs ;  but  if  he  meant  that  they  were  thus  hatched 
in  the  caecum,  colon,  or  rectum,  all  the  evidence 
obtained  by  later  investigations  goes  to  disprove  his 
interpretation  of  known  and  recognised  facts. 
According  to  Leuckart  the  escape  of  the  embryos 
from  the  eggs  "ordinarily  takes  place  under  the 
action  of  the  gastric  juice,  also  primarily  in  that 
condition  when  they  have  by  some  means  or  other 
gained  access  to  a  new  bearer/' 


THREADWORMS.  83 

If  this  view  does  not  convey  the  whole  truth,  it 
is  at  all  events  correct  as  far  as  it  goes,  and 
constitutes  an  important  advance  in  our  knowledge 
of  the  development  of  this  worm.  Moreover  it  has 
received  in  the  main  substantial  confirmation  from 
the  still  more  recent  and  elaborate  researches  of 
Professors  Zenker  and  Heller.  To  the  last  named 
observer,  whose  acquaintance  some  of  you  made 
when  he  was  over  in  this  country  last  summer,  I  am 
indebted  for  the  hint  already  named,  as  to  the  best 
modes  of  artificially  rearing  oxyurides,  and  I  have 
also  to  acknowledge  other  useful  contributions  at 
his  hands.  From  the  united  labours  of  these  two 
savans  it  is  now  quite  certain  that  the  entire  deve- 
lopmental phases  of  oxyuris  are  accomplished  within 
the  intestinal  canal  of  the  human  bearer;  and  for 
this  end  it  is  not  necessary  that  the  eggs  should 
find  a  new,  or  rather  a  second  human  bearer.  In 
other  words,  the  person  already  suffering  from 
Oxyurides  may  increase  the  numbers  of  his  enemies 
to  any  extent  by  accidentally  conveying  the  eggs  or 
worms  lodged  in  the  region  of  his  anus  into  his 
mouth.  This  he  may  do  during  sleep  quite  un- 
consciously ;  so  that  it  is  not  fair  to  charge  persons 
who  are  the  victims  of  this  disorder  with  uncleanli- 
ness.  On  the  other  hand,  it  occasionally  happens 
that  due  care  in  this  respect  has  not  been  exercised, 
and  from  such  persons  you  may  remove  the  eggs  of 
oxyurides  from  the  margins  of  the  finger  nails. 
G  2 


84  LECTURES. 

Whenever,  or  by  whatever  mode  the  eggs  are 
conveyed  to  the  mouth,  their  subsequent  passage 
to  the  stomach  insures  their  being  hatched,  and  the 
little  vermiform  embryos  are  soon  transferred  to  the 
duodenum  and  other  divisions  of  the  small  in- 
testine. In  this  situation  the  embryos  undergo  still 
more  remarkable  transformations,  casting  their 
skins,  and  growing  with  great  rapidity ;  being  at 
length  conveyed  to  the  csecum,  which  constitutes, 
so  to  speak,  their  head-quarters.  It  is  quite  an 
error  to  suppose  the  lower  bowel  or  rectum  forms 
their  especial  habitat;  nevertheless  you  will  find 
statements  of  this  kind  in  the  most  approved 
manuals,  vade-mecums,  general  treatises,  and  spe- 
cially contributed  articles. 

As  regards  the  organization  of  the  adult  worm, 
I  must  refer  you  again  to  my  larger  treatise,  and 
more  especially  also  to  the  admirable  monographs 
by  Professor  Bastian,  and  to  a  paper  by  my  col- 
league Mr.  Lowne. 

The  symptoms  produced  by  the  presence  of 
Oxyurides  in  the  caecum  and  large  intestine,  though 
seldom  or  never  fatal  to  the  bearer,  are  occasionally 
very  serious ;  whilst  in  the  mildest  cases  they  have  a 
tendency  to  undermine  the  general  health.  As 
I  have  observed  elsewhere,  the  unpleasant  sensa- 
tions chiefly  develop  themselves  in  the  evening 
and  at  night,  consisting  for  the  most  part  of 
sensations  of  heat  and  irritation  within  and  around 


THREADWORMS.  85 

the  margin  of  the  anus.  These  symptoms  in 
bad  cases  become  distressing  and  almost  in- 
tolerable, especially  when  the  itching  extends  to 
the  genito-urinary  passages,  in  consequence  of  the 
escape  and  migration  of  the  parasites  about  these 
parts.  By-and-by  the  local  inflammatory  action 
thus  superinduced  sets  up  various  sympathetic 
phenomena,  such  as  restlessness,  general  nervous- 
ness, itchings  at  the  nose,  involuntary  twitchings, 
grinding  of  the  teeth  during  sleep,  chorea,  convul- 
sions, and  epileptiform  seizures.  At  the  age  of 
puberty  special  local  disorders  arise,  the  nature  of 
which  will  be  readily  understood  when  merely 
spoken  of  as  the  morbid  phenomena  of  sexual 
irritation.  In  the  female  the  occurrence  of  pruritus 
and  leucorrhoea  is  not  uncommon,  accompanied  or 
not,  as  the  case  may  be,  with  hysteria  in  various 
forms.  In  the  ordinary  run  of  cases  you  merely 
encounter  general  asthenia,  with  more  or  less 
emaciation.  The  anaemia  is  sometimes  remarkable; 
but  in  place  of  anorexia,  which  is  however  an 
occasional  concomitant,  you  frequently  find  a  most 
voracious  appetite,  especially  in  the  younger  patients. 
Sometimes  one  meets  with  all  sorts  of  obscure 
symptoms  simulating  those  of  local  organic  disease. 


LECTURE  XIII. 

Cases  XLIII.  to  LII.,  illustrating  the  more  ordinary  Methods  of 
Treatment — Employment  of  Santonin,  Podophyllin,  Areca-Nut, 
Chenopodium,  Buckthorn,  Salines,  Jalapin,  Scammony,  and 
other  Cathartics— Simple  and  Medicated  Enemata,  with  Lime- 
water,  Steel,  Sulphuric  Ether,  Quassia,  and  Tansy. 

GENTLEMEN, — Without  further  discussing,  in  general 
terms,  the  more  prevalent  symptoms  noticeable  in 
the  seat- worm  disorder,  I  proceed  to  offer  a  few 
illustrative  cases.  These  examples  will  suffice  to 
show  the  sort  of  treatment  I  have  hitherto  usually 
recommended  under  ordinary  circumstances.  In 
reference,  however,  to  the  question  as  to  the  possi- 
bility of  permanently  curing  the  disease  I  shall 
address  you  at  greater  length  presently.  J 

CASE  XLIII. — C.  W.  W.,  a  gentleman  residing 
at  Scarborough,  consulted  me  in  June,  1869,  and 
again  in  July,  1870.  For  some  years  past  he  had 
been  "  annoyed  by  ascarides,"  though  he  could  not 
be  said  to  have  suffered  from  them.  As  there  were 
no  marked  symptoms  I  prescribed  santonin  in  com- 
bination with  podophyllin  and  jalapin  in  small, 
perhaps  in  unnecessarily  small,  doses.  These  powders, 
in  association  with  the  employment  of  cold  water 


THREADWORMS.  87 

enemata,  had  the  effect  of  affording  temporary 
relief;  but  they  were  afterwards  abandoned  in 
favour  of  compound  scammony  powders,  followed 
by  active  saline  draughts  and  the  administration  of 
medicated  injections. 

CASE  XLIV. — S.  G.  J.,  a  gentleatan  past  the 
middle  age,  living  in  Gloucestershire,  has  been 
infested  by  threadworms  for  a  period  of  sixteen 
years,  their  presence  rendering  him  irritable  and 
nervous.  He  first  consulted  me  in  the  autumn  of 
1866 ;  and  when  I  saw  him  again  in  the  following 
December,  he  admitted  that  he  had  derived  relief 
from  the  treatment  recommended.  In  the  first 
instance,  I  had  here  also  employed  santonin  in 
combination  with  senna,  and  the  use  of  copious 
enemata.  This  treatment  was  subsequently  modi- 
fied, with  decidedly  better  effect,  by  ordering  san- 
tonin and  podophyllin  supplemented  by  injections 
containing  sulphuric  ether.  In  the  following  spring, 
when  I  saw  him  for  the  last  time,  the  improvement 
observed  was  such  that  I  merely  advised  a  renewal 
of  the  enemata  whenever  occasion  required. 

CASE  XLV. — G.  R.,  a  gentleaten  about  sixty 
years  of  age,  also  from  Gloucestershire,  first  saw 
me  in  April,  1866.  He  has  been  troubled  with 
these  obnoxious  parasites  all  his  lifetime  hitherto. 
Their  presence  had  not  only  rendered  him  highly 
nervous,  but  he  suffered  from  depression  of  spirits, 
accompanied  with  great  debility  and  considerable 


LECTURES. 

emaciation.  In  accordance  with  my  advice,  he 
persevered  in  the  employment  of  copious  enemata, 
preceded  by  the  use  of  powders  containing  santonin. 
Unfortunately,  active  purgatives  could  not  be  borne, 
although  when  I  last  saw  him  in  December,  1870, 
I  so  far  prevailed  upon  him  as  to  induce  him  to 
take  powders  containing  a  few  grains  of  scammony. 
Simple  cold  water  enemata,  however,  became  the 
most  acceptable  mode  of  treatment,  affording  only 
a  very  temporary  and  partial  relief.  x" 

CASE  XLVI. — S.  A.  W.,  a  magistrate  from  Sussex, 
about  fifty-five  years  of  age,  has  also  been  annoyed 
all  his  lifetime  by  ascarides.  He  suffers  chiefly 
from  depression  of  spirits,  being  at  times  almost 
hypochondriacal.  He  has  tried  various  remedies 
without  success.  When  I  first  saw  him,  which  was 
in  April,  1866,  I  recommended  electuaries  of  san- 
tonin and  cold  water  enemata.  With  some  slight 
changes,  this  simple  method  of  treatment  was  con- 
tinued for  a  month.  Large  numbers  of  parasites 
were  brought  away,  and  on  the  16th  of  the  following 
May  I  received  a  note  stating  that  up  to  that  time 
there  had  been  "  no  return  of  the  inconvenience." 
The  good  effects,  indeed,  lasted  until  the  middle  of 
June,  during  which  month  there  was  a  recurrence 
of  the  irritation,  "  though  to  no  great  extent." 
The  temporary  relief  thus  afforded  appeared  to  give 
satisfaction,  the  patient  being  contented  to  renew  the 
remedies  whenever  they  might  become  necessary. 


THREADWORMS.  89 

CASE  XL VII. — C.  F.,  a  gentleman  from  Glouces- 
tershire, placed  himself  under  my  advice  on  the 
19th  May,  1866.  Though  scarcely  thirty  years 
of  age,  he  had  become  extremely  weak,  and  he  was 
subject  to  severe  fainting  fits,  sufficient  to  produce 
serious  alarm.  These  symptoms  were  attributed  to 
ascarides.  Here,  again,  I  was  induced  to  employ 
santonin ;  relying,  however,  chiefly  upon  lime-water 
enemata,  which  also  contained  steel.  On  the  4th  of 
the  following  June  I  learnt  by  letter  that  the  treat- 
ment had  caused  a  diminution  in  the  amount  of  irrita- 
tion ;  nevertheless,  some  ten  days  subsequently  I  was 
likewise  informed  that  there  had  been  a  recurrence 
of  one  of  the  severe  fainting  fits.  Acting,  very 
properly,  under  the  advice  of  his  usual  medical 
attendant,  the  santonin  powders  were  discontinued ; 
and  in  this  instance  it  was  believed  that  the  drug 
had  acted  prejudicially.  Occasionally,  though  very 
rarely,  I  have  seen  untoward  symptoms  arise  in 
other  patients  from  its  use. 

CASE  XLVIII.—  F.  F.,  a  gentleman  from  Strat- 
ford-on-Avon,  about  seventy  years  of  age,  has  been 
a  great  sufferer  from  threadworms  for  many  years 
past.  He  has  been  treated  by  various  physicians  with 
more  or  less  success,  and  has  found  more  good  from 
taking  copious  draughts  of  salt  and  water  than  from 
anything  else.  I  first  saw  him  in  November,  1866, 
and  have  had  opportunities  of  watching  the  case  from 
time  to  time  ever  since.  At  first  I  recommended 


90  LECTURES. 

santonin  powders  and  cold  water  enemata ;  but  the 
inefficiency  of  these  remedies  soon  caused  me  to 
substitute  powders  of  areca  nut  and  chenopodium, 
followed  by  active  saline  mixtures.  So  far  as  the 
parasites  were  concerned  this  treatment  seemed  to 
promise  more  success ;  but  the  necessity  of  discon- 
tinuing all  vigorous  treatment  of  this  sort  was 
afterwards  rendered  imperative  by  the  setting  in  of 
serious  paralytic  symptoms,  attended  with  aphasia 
and  extreme  depression.  Under  additional  profes- 
sional advice,  he  resorted  to  the  south  of  France. 
This  was  in  the  month  of  January,  1870.  Whilst 
there,  for  a  period  of  three  months  or  so,  he  expe- 
rienced a  decided  improvement  in  health,  but  it 
could  scarcely  be .  said  that  this  was  due  to  the 
change  of  residence,  since  the  climate  proved  too 
relaxing.  Under  my  advice  he  had  continued  the 
areca-nut  and  chenopodium  powders,  gaining  further 
aid  from  the  use  of  simple  enemata,  and  more  par- 
ticularly also  from  a  strict  adherence  to  rules  as  to 
wine  and  diet.  The  saline  draughts  could  not  be 
borne  at  any  time ;  and  the  employment  of  all  other 
active  purgatives  was  equally  contra-indicated. 

CASE  XLIX. — M.  G.,  a  gentleman  of  middle 
age,  residing  in  the  suburbs  of  London,  consulted 
me  in  May,  1867.  The  symptoms  in  this  case  were 
less  marked  than  usual.  The  employment  of  san- 
tonin and  podophyllin  electuaries,  with  other  injec- 
tions, had  but  little  effect ;  but  the  subsequent  ad- 


THREADWORMS.  91 

ministration  of  santonin  in  combination  with  a 
saline  purgative  brought  away  considerable  numbers 
of  oxyurides.  At  a  later  period  I  prescribed  aloes, 
followed  by  quassia  enemata,  further  advising  only 
a  continuance  of  these  remedies  as  occasion  might 
seem  to  require.  It  was  not  a  case  requiring  very 
active  treatment. 

CASE  L. — C.  W.  A.,  about  thirty  years  of 
age,  a  gentleman  of  "independent  means,  has  for 
years  past  been  a  perfect  martyr  to  threadworm. 
His  appearance  indicated  suffering  of  no  ordinary 
kind,  for  he  was  reduced  to  a  mere  skeleton.  Every 
kind  of  treatment  has  been  recommended  by  his 
medical  advisers,  and  hitherto  with  only  a  very 
partial  relief.  At  first  1  employed  santonin  and 
podophylliu,  with  lime-water  enemata  containing 
steel;  but  as  this  form  of  injection  could  not  be 
retained  sufficiently  long  to  be  of  service,  I  after- 
wards recommended  a  twelve-ounce  enema  con- 
taining three  drachms  of  sulphuric  ether  and  a  few 
drops  of  the  oil  of  rue.  This  treatment  commenced 
in  January,  1867,  and  it  had  the  effect  of  driving 
out  a  large  number  of  parasites,  which  were  mostly 
dead.  At  the  expiration  of  two  months  the  thread- 
worms ceased  to  appear,  and  the  relief  was,  of 
course,  well  marked.  The  cure,  however,  was  only 
very  temporary ;  for  in  the  course  of  another  month 
or  six  weeks  the  attacks  recommenced.  I  then 
recommended  the  frequent  use  of  injections  con- 


92  LECTURES. 

sisting  of  equal  parts  of  the  infusions  of  tansy  and 
quassia,  some  sulphuric  ether  being  still  added. 
Excellent  temporary  results  once  more  followed,  to 
be  again  and  again  experienced  on  subsequent  re- 
newals of  this  treatment,  which,  as  the  patient 
himself  admitted,  had  done  him  more  good  than 
any  of  the  other  measures  he  had  been  previously 
advised  to  adopt. 

CASE  LI. — M.  R.,  a  married  middle-aged  lady, 
consulted  me  for  threadworms  on  the  20th  March, 
1868.  Her  symptoms  presented  nothing  remark- 
able ;  but  the  inconvenience  thus  occasioned  almost 
amounted  to  distress.  I  prescribed  rhubarb,  jalap, 
and  santonin,  with  the  exhibition  of  enemata  contain- 
ing steel.  I  also  recommended  the  local  use  of  mer- 
curial ointment,  to  prevent  the  nocturnal  migration 
of  the  parasites  in  the  neighbourhood  of  the  funda- 
ment. At  the  expiration  of  a  week  I  discontinued 
the  powders,  substituting  electuaries  of  jalap  and 
podophyllin,  followed  by  a  cathartic  mixture.  Con- 
siderable advantage  following  this  mode  of  treat- 
ment, I  finally  advised  its  repetition  as  often  as 
occasion  might  require.  The  patient  being  rather 
strengthless  and  antemic,  I  likewise  prescribed  a 
tonic  containing  the  ammonio-citrate  of  iron. 

CASE  LII. — R.  T.,  a  middle-aged  clergyman,  con- 
sulted me  in  September,  1869.  He  has  had  tape- 
worm, and  was  successfully  treated  by  the  male- 
fern  method,  after  the  previous  frequent  and  inef- 


THREADWORMS.  93 

fectual  employment  of  kousso  and  turpentine.  He  is 
now  suffering  from  oxyurides  exclusively;  the 
excessive  local  irritation  being  productive  of  irri- 
tability, depression  of  spirits,  vertigo,  and  occasional 
pains  in  the  region  of  the  pylorus.  In  the  first 
instance  I  prescribed  santonin  and  oil  of  chenopo- 
dium,  along  with  the  syrup  of  buckthorn.  This 
medicine  operated  vigorously,  but  only  afforded 
trifling  relief.  This  feeble  result  was  scarcely  to 
be  wondered  at,  seeing  that  under  other  medical 
advice  he  had  previously  tried  all  sorts  of  powerful 
drugs,  such  as  scammony  and  jalap,  along  with 
enemata  of  lime  water  containing  steel.  I  also 
subsequently  prescribed  powders  containing  santonin 
and  scammony,  supplemented  by  saline  draughts. 
This  mode  of  treatment  proved  somewhat  more 
efficient. 


LECTURE   XIV. 

The  Parasitism  of  Threadworms  is  occasionally  complicated  by  other 
Diseases — Cases  LIII.  and  LIV. — Oxyurides  in  Children  are 
frequently  overlooked — Cases  LV.  to  LIX. — Insufficiency  of 
the  Ordinary  Remedies — Liability  of  the  Disorder  to  Return 
after  apparently  effective  Treatment. 

GENTLEMEN,— The  foregoing  instances  very  fairly 
illustrate  the  ordinary  run  of  cases  which  come 
under  niy  care ;  but  ever  and  anon  I  meet  with 
patients  whose  sufferings  are  far  greater,  and 
whose  helminthiasis,  so  to  say,  is  complicated  by 
other  disorders.  In  such  instances  it  is  rather 
puzzling  to  know  what  course  to  adopt,  because 
the  remedies  which  are  suitable  for  the  worms 
may  aggravate  the  disorder  of  which  the  parasites 
were  not  the  primary  cause.  Or  again,  the  symp- 
toms of  irritation  from  the  worms  alone  may  be 
so  serious  that  all  active  remedies  are  resisted  by 
the  sufferer.  The  next  two  cases  will  perhaps 
sufficiently  illustrate  these  points. 

CASE  LIII. — W.  L.  B.,  a  young  lady  residing 
at  the  West-end  of  the  metropolis,  solicited  my 
opinion  in  the  spring  of  1867.  She  had  been 


THREADWORMS.  95 

troubled  with  threadworms  from  childhood,  and 
had  undergone  all  sorts  of  treatment  without  any 
manifest  advantage.  She  appeared  to  be  as  it 
were  "  eaten  up  with  worms/'  and  in  addition  to 
the  ordinary  symptoms  superinduced  by  these  crea- 
tures they  had  brought  on  severe  chlorotic  symp- 
toms, ansemia,  asthenia,  and  utter  prostration, 
accompanied  with  complete  deafness.  In  fact,  I 
found  her  in  an  apparently  moribund  condition. 
Naturally  it  was  difficult  to  say  what  was  the  best 
treatment  to  advise,  as  the  system  required  every 
kind  of  support,  while  at  the  same  time  the  para- 
sites were  the  true  cause  of  her  ruined  health.  At 
some  risk  I  ordered  a  brisk  purgative  containing 
spigelia,  but  the  action  was  too  powerful  to  allow 
of  her  taking  a  second  dose.  I  subsequently  en- 
couraged the  use  of  enemata ;  but  the  patient's 
previous  experiences  seemed  only  to  induce  despair 
as  to  any  good  results  being  obtainable  from  this 
source.  The  case  is  instructive,  as  showing  the 
necessity  of  treatment  before  the  time  arrives  when 
active  anthelmintics  can  no  longer  be  borne. 

CASE  LIV. — H.  H.  T.,  a  surveyolr,  of  middle  age, 
requested  advice  on  the  12th  July,  1869.  With 
a  foul  tongue,  depressed  look,  and  remarkable  dul- 
ness  about  the  eye,  there  was  continual  trembling 
of  the  upper  limbs,  especially  of  the  right  limb, 
attended  with  general  restlessness,  hemicrania,  and 
anxiety.  He  could  not  even  hold  a  pen  to  write. 


96  LECTURES. 

These  symptoms  had  existed  for  five  years,  but  they 
were  not  in  the  first  instance  attributed  to  the  pre- 
sence of  oxyurides.  The  parasites,  indeed,  were 
not  observed  until  a  year  later,  and  when  first  seen 
were  only  noticed  in  very  small  numbers.  Some 
of  his  symptoms  led  me  to  suspect  the  existence  of 
Bright' s  disease  ;  but  on  submitting  the  urine  to 
the  ordinary  tests  I  could  discover  no  trace  of  al- 
bumen. Anxious  therefore  to  ascertain  the  extent 
of  the  parasitism,  I  prescribed  santonin  in  combina- 
tion with  an  active  saline  purgative.  This  medicine 
operated  very  efficiently,  but  only  expelled  two  ex- 
amples of  the  threadworm.  Having  satisfied  both 
the  patient's  mind  and  my  own  that  no  serious  mis- 
chief was  arising  from  this  source,  I  prescribed  a 
vegetable  tonic,  and  countenanced  a  proposal  that 
he  should  quit  business  for  a  time  and  repair  to  the 
sea-side.  This  step  proved  of  the  utmost  benefit, 
and  when  I  saw  him  again  in  the  following  Sep- 
tember he  had  a  good  appetite,  a  clean  tongue,  a 
bright  look,  a  soft  and  regular  pulse,  with  an  almost 
total  disappearance  of  the  trembling  of  the  upper 
right  limb.  Such  good  results  thus  far  encouraged 
me  to  recommend  a  trial  of  the  bromide  of  potas- 
sium ;  yet  I  am  free  to  state  that  its  employment 
did  more  harm  than  good.  At  all  events,  the  as- 
thenic  and  dyspeptic  symptoms  returned,  with  some 
other  features  of  the  old  disorder.  Of  course  I 
counselled  a  repetition  of  the  previous  treatment, 


THREADWORMS.  97 

which  had  proved  so  successful ;  but  I  have  not 
since  learned  what  results  followed.  I  think  it 
quite  possible  that  if  in  place  of  the  bromide  I  had 
prescribed  the  ferro-cyanide  of  potassium  a  further 
improvement  in  the  nervous  system  would  have 
continued  to  show  itself. 

In  regard  to  the  prevalence  of  ascarides  amongst 
children,  it  is  well  known  that  they  are  extremely 
common,  and  that  their  presence  is  frequently  over- 
looked; but  there  is  this  to  be  said  also,  that  when 
detected  they  are  as  a  rule  less  difficult  to  get  rid 
of  than  obtains  in  the  case  of  adults.  The  reason 
of  this  is  no  doubt  partly  owing  to  the  circumstance 
that  the  bowels  are  much  more  readily  cleared  by 
simple  purgatives.  The  folds  of  the  intestines  are 
less  numerous,  and  present  fewer  opportunities  for 
the  parasites  to  avoid  the  action  of  the  remedies. 
In  very  bad  cases,  however,  the  most  active  purga- 
tion is  of  little  avail,  save  as  affording  temporary 
relief.  Undoubtedly  saline  draughts  and  copious 
enemata  frequently  constitute  the  most  simple  and 
effective  treatment.  I  have  tried  various  other 
remedies  with  more  or  less  success.  Here  are 
a  few  cases  selected  more  on  account  of  the 
symptoms  and  other  peculiarities  than  as  illus- 
trating the  comparative  merits  of  particular 
remedies. 

CASE  LV. — P.  B.,  a  respectable  lad,  ten  years 
of  age,  sought  my  advice  in  the  spring  of  1870. 

H 


98  LECTURES. 

From  his  mother's  account  the  boy's  sufferings  were 
extreme,  the  irritation  causing  irritability  and  dis- 
tress during  the  day  and  convulsive  twitchings  at 
night.  He  was  pale  and  emaciated.  Anxious  to 
try  a  remedy  much  extolled  in  India,  I  at 
first  gave  small  doses  of  the  powdered  seeds 
of  Butea  frondosa,  with  scammony  and  ginger. 
Though  the  medicine  operated  efficiently  no  para- 
sites came  away  until  the  employment  of  the 
third  dose,  the  action  of  which  had  been  in- 
creased by  a  spoonful  of  Epsom  salts.  Only  a 
score  or  so  of  the  oxyurides  having  been  thus 
dislodged,  I  subsequently  advised  the  employ- 
ment of  calomel  and  compound  scammony  powder  ; 
but  I  had  no  opportunity  of  further  watching 
the  case. 

CASES  LVI.  AND  LVIL— H.  A.  W.  and  P.  W., 
young  gentlemen  of  seven  and  ten  years  of  age 
respectively,  and  brothers,  visited  me  on  the 
25th  October,  1870.  In  each  case  there  was 
anaemia,  loss  of  flesh  and  tone,  with  nasal  and  anal 
irritation.  The  younger  boy  had  a  remarkably 
weak  pulse,  with  a  constant  watery  suffusion  of 
the  eyes.  They  had  been  treated  with  turpentine, 
which  produced  violent  dysuria  and  other  un- 
pleasant symptoms.  For  the  one  I  prescribed 
scammony  and  salt,  and  for  the  other  scammony, 
calomel,  and  santonin.  These  remedies  were  fol- 
lowed by  the  employment  of  cold  water  enemata 


THREADWORMS.  99 

and  tonics.  In  both  cases  the  treatment  proved 
decidedly  beneficial. 

CASE  LVIII. — C.  M.,  a  young  gentleman  nine 
years  of  age,  residing  in  the  suburbs  of  London, 
was  brought  to  me  on  the  24th  April,  1868. 
Here  also,  in  addition  to  the  extreme  pallor  and 
some  emaciation,  there  was  the  usual  restlessness, 
with  disturbed  sleep  and  convulsive  startings  at 
night.  He  had  been  treated  with  ordinary  pur- 
gatives and  saline  injections.  These  remedies  had 
evidently  done  good  service;  nevertheless  the  at- 
tacks recurred  from  time  to  time,  and  he  con- 
tinued to  pass  threadworms  "by  hundreds  and 
thousands."  Under  my  instructions  the  ad- 
ministration of  jalap  and  santonin  powders, 
followed  by  a  senna  mixture,  and  the  use  of 
ether  enemata,  had  the  effect  of  once  more 
restoring  him  to  a  state  of  comparative  com- 
fort— at  least  such  was  the  case  when  I  last  saw 
him,  at  the  expiration  of  a  month  only  after  his 
first  visit. 

CASE  LIX. — E.  T.,  a  young  gentleman,  fifteen 
years  of  age,  consulted  me  on  the  8th  April, 
1868.  The  irritation  arising  from  the  presence  of 
worms  was  excessive,  producing  nervousness,  head- 
ache, gnawing  pains  across  the  abdomen,  and  a 
continual  craving  for  food.  In  this  instance  I  pre- 
scribed an  active  powder,  containing  jalap,  santonin, 
and  rhubarb,  followed  by  an  aperient  of  senna,  and 
H  2 


100  LECTURES. 

the  employment  of  an  injection  containing  ether 
and  quassia.  The  effect  was  described  as  magical, 
the  medicines  causing  the  evacuation  of  "  enormous 
quantities"  of  parasites.  Subsequent  doses  (with 
some  slight  alteration  of  the  prescriptions)  only 
brought  away  a  very  few  more  worms,  for  the 
simple  reason  that  only  a  very  small  number  had 
been  left  behind  to  operate  on.  The  temporary 
cure  in  this  instance  left  little  more  to  be  desired 
in  the  way  of  treatment,  and  at  the  expiration  of 
a  month,  when  I  last  saw  him,  the  good  results  were 
fully  maintained. 

Without  needlessly  multiplying  cases  like  the 
foregoing,  I  may  observe  that  their  record  suffices 
to  illustrate  the  usual  measure  of  success  which 
attends  the  more  ordinary  methods  of  treating 
them.  As  you  may  have  noticed,  the  results  are 
not  entirely  satisfactory,  for  the  disorder  is  ca- 
pricious, and  constantly  liable  to  return,  even  after 
your  success  appears  to  be  complete.  Now  and 
then,  however,  one  meets  with  a  case  where  the  cure 
remains  permanent,  and  I  can  remember  one  pa- 
tient, a  nonconformist  minister,  who  obtained  this 
result  simply  by  the  use  of  aperients  and  enemata 
containing  two  or  three  drachms  of  sulphuric  ether. 
Though,  in  deference  to  the  statements  of  practi- 
tioners abroad,  I  have  often  employed  santonin, 
podophyllin,  and  chenopodium,  the  latter  both  in 
oil  and  powder,  I  am  bound  to  say  that  any  good 


THREADWORMS.  101 

results  following  their  use  generally  appeared  to 
me  to  be  principally  attributable  to  the  aperients 
employed  to  increase  their  action.  The  seeds  of 
Butea  frondosa,  and  several  other  drugs  rarely 
prescribed  in  this  country,  have  also  disappointed 
my  expectations. 

Those  who  desire  to  try  any  more  new  drugs, 
with  the  view  of  introducing  them  into  British 
practice,  should  previously  consult  Dr.  E.  J. 
Waring' s  brochure,  entitled  "  Notes  on  some  of  the 
principal  Indigenous  Anthelmintics  of  India." 


LECTURE    XV. 

Salines  with  Enemata  constitute  the  most  effective  Treatment — 
Saline  Mineral  Waters  especially  recommended — Some  Patients 
cannot  bear  vigorous  Treatment  of  any  kind— Cases  LX.  to 
LXV. — Personal  Cleanliness  is  the  best  Preventive  against 
Infection. 

GENTLEMEN, — If  it  be  asked  what  remedies  I  have 
found  most  beneficial  I  do  not  hesitate  to  say  that 
the  exhibition  of  salines  generally,  and  especially  of 
natural  mineral  waters,  aided  by  the  use  of  injec- 
tion, has  afforded  me  the  most  satisfactory  results. 
Of  course  a  judicious  choice  of  these  waters  is 
necessary ;  but  those  which  contain  the  largest 
proportions  of  chloride  of  sodium  and  sulphate  of 
magnesia,  in  combination  with  iodides  and  bromides, 
are  most  worthy  of  trial.  In  this  view  I  am  in  the 
habit  of  recommending,  more  particularly,  the  waters 
of  Friedrichshall  and  Pullna;  but  the  Carlsbad, 
Homburg,  and  Kissingen  waters  are  perhaps  nearly 
as  efficient.  Upon  further  trial  it  would  not 
surprise  me  if  the  Woodhall  Spa  of  Lincolnshire 
should  prove  itself  superior  to  any  of  the  foreign 
waters;  but  as  this  water  requires  to  be  aided  by 
purgative  drugs,  I  have  chiefly  relied  upon  the 


THREADWORMS.  103 

sufficiently  saline  water  of  Friedrichshall,  which 
perhaps  has  an  advantage  over  the  Pullna  in  its 
strong  degree  of  bitterness.  Of  course  there  are 
cases  in  which  the  use  of  these  waters  is  contra- 
indicated  ;  as,  for  example,,  in  patients  who  object  to 
large  potations  of  any  kind..  In  such  cases  the 
prepared  salts  may  be  prescribed  with  advantage ; 
this  being  a  method  of  treatment  frequently  adopted 
on  the  Continent.  In  the  few  following  cases,  as 
in  all  the  foregoing,  I  have  alike  recorded  perfectly 
and  imperfectly  successful  cases;  for  I  have  little 
sympathy  with  those  who  think  that  medical  science 
js  advanced  only  by  recording  remarkable  or  won- 
derful cures. 

CASE  LX. — D.  A.,  a  member  of  the  profession, 
under  middle  age,  visited  me  in  December,  1868. 
He  informed  me  that  the  active  duties  of  a  large 
practice  were  rendered  doubly  arduous  by  the 
irritation  arising  from  the  presence  of  large  num- 
bers of  threadworms ;  and  he  has  been  afflicted  in 
this  way,  more  or  less,  from  boyhood.  At  first  I 
suggested  the  employment  of  jalapin,  podophyllin, 
and  santonin,  leaving  the  question  of  the  frequent 
use  of  enemata  to  his  own  experienced  judgment. 
However,  little  or  no  good  following  this  and  other 
comparatively  lenient  modes  of  treatment,  I  lately 
urged  the  employment  of  sulphur  and  charcoal 
powders,  followed  by  draughts  of  the  bitter  and 
saline  Friedrichshall  waters.  Unfortunately  neither 


1 04  LECTURES. 

the  one  nor  the  other  of  these  remedies  could  be  borne, 
the  water  being  described  "  as  so  bitter  and  salt 
that  the  stomach  would  not  retain  it."  Discarding 
therefore  these  active  remedies,  he  has  been  obliged 
to  content  himself  with  a  milder  form  of  treatment, 
and  has  since  found  considerable  benefit  by  taking 
"  every  morning,  early,  a  tumblerful  of  strong 
infusion  of  gentian  on  an  empty  stomach."  Should 
this  measure  of  good  not  be  maintained,  it  is  pro- 
posed to  return  to  the  mineral  water  treatment  in 
a  modified  form. 

CASE  LXI. — B.  R.,  a  retired  lieutenant-colonel, 
sought  my  advice  on  the  13th  January,  1871. 
His  age  is  about  seventy,  and  he  has  suffered  from 
these  threadworm  pests  ever  since  he  attained  his 
majority.  He  has  been  treated  with  aloes,  sulphur, 
and  other  drugs,  aided  by  quassia  and  saline  injec- 
tions. He  had  likewise  been  induced  to  try  the 
homoeopathic  method;  the  results  being,  as  you  would 
naturally  suppose,  eminently  unsatisfactory.  In  this 
case  I  advised  a  continuance  of  the  enemata,  sub- 
stituting steel  instead  of  salt;  but  I  relied  more 
especially  upon  the  use  of  powders  of  scammony, 
santonin,  and  sulphur,  washed  down  by  copious 
draughts  of  Friedrichshall  water.  Unfortunately  this 
patient  could  only  bear  a  trifling  amount  of  purga- 
tion ;  nevertheless,  the  treatment  proved  decidedly 
beneficial. 

CASE    LXJI. — N.    H.    J.,    a    clergyman,    from 


THREADWORMS.  105 

Norfolk,  about  fifty  years  of  age,  has  been  a  great 
sufferer  from  oxyurides.  The  irritation  thus  occa- 
sioned has  sometimes  been  so  extreme  that  his 
public  duties  have  been  carried  on  with  great 
difficulty.  He  had  been  recommended  to  take 
steel,  but  found  its  employment  detrimental  to  his 
general  health ;  on  the  other  hand,  he  has  derived 
great  advantage  from  the  use  of  the  natural  waters 
of  Homburg,  and  during  his  occasional  visits  at  the 
spa  he  appears  to  have  been  perfectly  free  from 
any  parasitic  annoyances.  The  entozoa  have,  how- 
ever, invariably  reappeared  shortly  after  his  return 
to  England.  Partly  in  imitation  of  the  mineral 
water  treatment  I  advised  the  taking  of  saline 
aperients,  followed  by  the  frequent  employment  of 
enemata  of  strong  infusions  of  quassia  and  tansy. 
This  treatment  had  the  effect  of  bringing  away 
great  nnmbers  of  parasites;  but  he  never  feels 
himself  to  be  entirely  free  of  his  enemies  except 
when  actually  residing  at  Homburg. 

CASE  LXIII. — M.  H.,  a  young  lady  twenty  years 
of  age,  residing  in  the  northern  suburbs  of  London, 
is  subject  to  repeated  attacks  of  threadworm.  They 
have  tormented  her  for  some  six  years  past,  during 
which  time  she  has  been  constantly  dyspeptic; 
being  also  subject  to  frequent  bleedings  at  the 
mouth  in  the  early  morning.  Most  of  her  symptoms, 
however,  were  those  of  chlorosis.  The  marked 
anaemia  and  puny  state  of  the  skin,  together  with 


106  LECTURES. 

significant  indications  of  impairment  of  the  circula- 
tion and  uterine  organs,  seemed  to  me  to  be  fully 
accounted  for  on  this  assumption ;  and  the  more  so 
since  I  did  not  learn  that  the  oxyurides  were  at 
any  time  particularly  numerous.  In  the  first 
instance  I  ordered  sulphur  and  charcoal  powders, 
along  with  moderate  draughts  of  the  Friedrichshall 
mineral  waters.  The  results  being  negative  as 
regards  the  parasites,  I  next  advised  a  temporary 
discontinuance  of  the  anthelmintic  remedies,  sub- 
stituting a  powerful  tonic  containing  steel,  quinine, 
and  strychnia.  This  treatment,  materially  strength- 
ened by  a  prolonged  stay  in  the  south-west  of 
England,  produced  excellent  results;  but  as  the 
threadworms  returned  I  was  again  consulted. 
Finally  I  recommended  the  Pullna  waters,  as  being 
more  powerful  than  those  she  had  previously  taken, 
but  even  this  treatment  failed  to  dislodge  any 
considerable  number  of  worms.  In  point  of  fact, 
the  degree  of  parasitism  in  this  case  was  compara- 
tively trifling ;  but  amply  sufficient,  nevertheless,  to 
aggravate  the  uterine  symptoms,  nine-tenths  of 
which  were  due  to  one  of  the  commonest  of  female 
disorders. 

CASE  LXIV. — H.  S.,  a  young  lady,  resident  in 
Germany,  sought  my  advice  through  her  parent  in 
the-  spring  of  1871.  The  symptoms  were  of  the 
ordinary  type,  but  decidedly  severe.  I  commenced 
treatment  by  employing  steel  injections,  with  san- 


THREADWORMS.  107 

tonin  and  scammony,  in  the  form  of  electuary, 
further  accelerated  in  its  action  by  one-ounce  doses 
of  castor-oil.  These  remedies,  employed  for  three 
successive  days,  produced  excellent  effects;  lasting 
for  a  fortnight,  at  the  expiration  of  which  period  it 
was  found  necessary  to  repeat  them.  More  or  less 
perfect  relief  again  followed,  the  good  effects  ex- 
.  tending  over  a  period  of  at  least  six  weeks.  At  the 
next  return  of  the  parasitic  symptoms,  which  was 
in  the  month  of  July,  I  prescribed  sulphur  and 
charcoal  powders,  followed  by  copious  draughts  of 
the  Saxe-Meiningen  mineral  waters ;  this  mode  of 
treatment  proved  most  successful.  When  I  last 
heard  from  her  the  freedom  "  from  any  annoyance" 
had  become  complete;  the  Friedrichshall  waters 
and  other  drugs  having  been  found  both  "  agreeable 
and  effective." 

CASE  LXV. — H.  J.,  a  distinguished  man  of 
science  and  letters,  of  middle  age,  is  subject  to 
occasional  attacks  of  ascarides,  which  of  late  years 
have  become  more  frequent  and  severe.  I  first 
prescribed  for  this  gentleman  in  the  month  of 
December,  1868 ;  recommending  podophyllin  and 
santonin  powders  with  cold-water  injections.'  This 
treatment  proving  altogether  unsatisfactory,  I  lost 
sight  of  the  case  for  a  considerable  period,  but  in 
the  following  year  I  had  an  opportunity  of  recom- 
mending a  modification  of  this  treatment.  Fresh 
attacks,  however,  continuing  to  recur  at  intervals,  I 


108  LECTURES. 

tried  (in  January,  1871)  my  sulphur  and  charcoal 
method,  aided  by  the  waters  of  Friedrichshall.  At 
the  expiration  of  a  month  this  patient  called  to  say 
that  he  had  already  derived  much  benefit  from  this 
mode  of  treatment ;  and  subsequently,  at  the  ex- 
piration  of  another  month,  he  wrote  to  tell  me  that 
the  treatment  had  been  te  perfectly  successful."  I 
also  ascertained  at  a  much  later  period  that  these 
good  effects  continued,  and  I  believe  that  they  do 
so  to  this  present  hour. 

Such  are  some  of  my  experiences  with  this 
troublesome  disorder,  and  I  think  you  will  admit 
that  guided  by  a  correct  knowledge  of  the  more 
recent  contributions  to  the  natural  history  of  this 
parasite,  we  have  at  length  arrived  at  a  better 
system  of  counteracting  and  checking,  if  not  of 
absolutely  curing  the  disease  which  it  occasions. 
Personal  cleanliness  is  certainly  essential.  A  recent 
writer,  who  is  at  the  same  time  a  very  accurate 
observer  in  other  departments  of  biology,  has 
ventured  to  hazard  a  statement  to  the  effect  that 
"  probably  any  infected  person  who  adopted  the 
requisite  precautions  against  reinfection  from  him- 
self or  others  would  get  well  in  a  few  weeks 
without  treatment  fty  drugs."  Dr.  Ransom  bases 
his  belief  on  the  known  facts  of  the  life-history 
of  this  entozoon,  as  recorded  in  his  article,  which 
gives  a  resume  of  the  views  of  Leuckart.  I 
regret  that  I  cannot  fully  share  Dr.  Ransom's 


THREADWORMS.  109 

notions  on  this  point ;  and  still  less  should  I  think 
it  fair    by   my  silence    to    appear  to    endorse    his 
rather  nauseating  statement  to   the   effect,   "that 
every   person   who   is    shown   to  be   infested  with 
those  very  common    entozoa,   Oxyuris  vermicularis 
and  Trichocephalus  dispar,  is  thereby  demonstrated 
to  have  swallowed  minute  portions  of  his  own  or 
another  person's  faeces."    I  respectfully  submit  that 
this  is    putting  the  case  too  strongly.     No  doubt 
the  eggs  of  oxyurides  swallowed  by  ourselves  must 
have  previously  passed  through  some  person's  rec- 
tum; as  such,  either  separately  or  mayhap  collec- 
tively, in  the  body  of  the  maternal  parasite.      That 
does  not,  however,  justify  Dr.  Ransom's  unpleasant 
statement,  to  the  effect  that  we  must  "  have  swal- 
lowed" particles  of  our  own  or  of  some  other  person's 
excrement.     The    eggs  are  not  to  be  regarded  as 
constituent  portions  of  the  faecal  matter,  but  rather 
as  the  products  of  the  legitimate  inhabitants  of  the 
human  intestinal  territory.      Even  should  you  still 
maintain  the   old  notion,  that  they  are  "foreign 
bodies,"  that  would  not  entitle  them  to  be   called 
"  minute    portions "    of   the   fseces.      Perhaps    Dr. 
Ransom  will  say  that  the  surfaces  of  these  eggs, 
being  in    contact   with  faecal    matter,  must   carry 
infinitesimal  portions  of  the  fascal  matter  on  their 
surfaces,  and  it  is  to  such  invisible  particles  that  he 
refers.     As  however  a  large  proportion  of  the  ova 
escape    with    their   parents,  whilst    they    are    still 


110  LECTURES. 

lodged  in  the  maternal  body,  it  would,  I  hold, 
require  a  great  stretch  of  the  imagination  to  believe 
that  these  intra-uterine  ova  also  support  faecal 
matter  on  the  exterior  of  their  shells.  I  repeat  my 
conviction  therefore,  that  it  is  not  fair  to  state, 
without  reservation,  that  every  sufferer  from  this 
parasite  must  have  "  swallowed  minute  portions  of 
his  own  or  another  person's  faeces."  Eggs  are  not 
faeces,  neither  when  swallowed  are  they  necessarily 
covered  or  contaminated  with  faecal  matter. 


LECTURE   XVI. 

The  Ascarides  properly  so-called — Lumbrici  not  common  in  Eng- 
land— Ascaris  mystax  still  rarer  in  Man — Eggs  of  the  Hound- 
worm  ejected  from  the  Stomach — Ascarides  common  Abroad  — 
Symptoms  similar  to  those  produced  by  Oxyurides — Singular 
Habits  of  Ascaris  Jumbricoides — Often  solitary  in  this  Country — 
Cases  LXVI.  to  LXX. 

GENTLEMEN, — I  have  purposely  dwelt  thus  long  on 
the  tapeworms  and  threadworms  because  these 
parasites  give  rise  to  diseases  respecting  which  you 
are  sure,  sooner  or  later,  to  be  consulted.  If,  by 
way  of  illustration,  I  have  adduced  more  cases 
from  my  experiences  with  the  tapeworm  than  with 
the  threadworm  class  of  disorders,  it  is  not  because 
the  latter  have  less  frequently  come  before  me  in 
practice,  but  because  the  former  are  more  varied 
in  character,  and  therefore  more  worthy  of  study. 
Some  of  the  rarer  kinds  of  parasitism,  indeed,  are 
even  more  instructive  than  any  of  those  I  have  thus 
far  described,  but  I  fear  the  limits  of  my  available 
time  will  not  allow  me  to  give  to  their  consideration 
all  the  attention  they  deserve. 

In  regard  to  the  ascarides,  properly  so  called,  I 
cannot  now  enter  at  any  length  into  the  question 


112  LECTURES. 

of  their  mode  of  development ;  although,  had  I 
sufficient  time  and  opportunity  at  my  command,  a 
discussion  of  this  kind  might  be  offered  with  very 
great  advantage.  In  my  large  illustrated  work  I 
have  devoted  some  six  or  more  pages  to  purely  prac- 
tical matters  connected  with  the  presence  of  Ascaris 
lumbricoides  in  the  human  subject,  but  the  compa- 
rative infrequeucy  of  the  occurrence  of  this  entozoon 
in  England  renders  it  less  incumbent  upon  me  to 
add  to  the  details  I  have  there  given.  Then  again 
as  regards  the  Ascaris  mystax,  which  I  had  the 
good  fortune  first  to  recognise  as  a  possible  member 
of  the  human  parasitic  fauna,  so  to  speak,  only  some 
half  dozen  cases  have  been  observed  and  placed  on 
record.  In  British  practice,  I  repeat,  you  will 
rarely  meet  with  cases  of  Ascaris  lumbricoides — i.e. 
of  Lumbrici,  or  Roundworms,  as  they  are  more 
frequently  called.  When  you  do  meet  with  them 
they  are  not  difficult  to  manage,  and  it  is  only  very 
rarely  that  more  than  one  worm  is  present.  Occa- 
sionally, especially  in  hospital  and  dispensary  prac- 
tice, you  will  find  several  of  these  parasites  occupy- 
ing the  same  bearer,  and  only  last  year  Mr.  De 
Morgan  had  a  patient  at  the  Middlesex  Hospital 
from  whom  as  many  as  thirty-seven  were  expelled. 
As  a  rule  the  presence  of  ascaris  in  the  human  sub- 
ject is  not  detected  before  the  patient  has  passed  a 
worm  either  by  the  mouth  or  anus ;  but  I  have  known 
of  one  or  more  instances  of  successful  diagnosis 


KOUNDWORMS.  113 

having  been  made  in  the  absence  of  the  above-men- 
tioned evidence,  and  I  have  myself  discovered  the 
eggs  of  Ascaris  lumbricoides  in  vomited  matters 
where  no  suspicion  of  the  presence  of  lumbrici 
appears  to  have  been  entertained. 

Should  circumstances  carry  you  abroad  you  may 
happen  to  take  up  your  residence  in  localities 
where  the  lumbricus  occurs  endemically,  and  in 
such  situations  the  presence  of  a  single  worm 
only  in  the  bearer  is  probably  the  exception  rather 
than  the  rule.  The  Mauritius  is  such  a  locality ; 
and  in  the  pages  of  the  Medical  Gazette  for  1834 
you  will  find  an  able  paper  by  Professor  Robert 
Dyce,  of  Aberdeen,  "  on  the  causes  of  their  preva- 
lence in  that  island."  Without  particularizing  the 
various  instances  on  record,  I  will  only  add  that  in 
extreme  cases  from  one  to  five  hundred  and  upwards 
of  these  large  round  worms,  each  from  six  to  twelve 
inches  in  length,  have  been  found  to  infest  a  single 
human  bearer. 

Under  ordinary  circumstances  the  symptoms  to 
which  lumbrici  give  rise  resemble  very  closely  those 
produced  by  oxyurides.  As  I  have  elsewhere  stated  : 
"In  the  stomach  and  intestines  they  give  rise  to 
colic  and  shooting  pains  about  the  abdomen,  fol- 
lowed generally  by  dyspepsia,  nasal  itching,  nausea, 
vomiting,  and  even  diarrhoea.  Sometimes  also  there 
is  a  considerable  degree  of  cerebral  disturbance, 
attended  with  general  restlessness  and  convulsive 


114  LECTURES. 

twitchings  during  sleep."  In  very  severe  cases 
amaurosis,  catalepsy,  convulsions,  erotomania,  and 
death  by  enteritis,  or  by  perforation  of  the  intestine, 
have  been  known  to  occur.  These  parasites  have 
a  remarkable  tendency  to  grope  about  the  intestinal 
canal  as  if  seeking  a  new  habitat,  and  thus  they  not 
unfrequently  make  their  way  into  the  various  parts 
of  the  body,  having  been  found  in  the  gall  duct,  the 
cavity  of  the  chest,  the  parietes  of  the  abdomen, 
and  in  various  other  strange  situations.  Many 
instances  are  on  record  of  their  having  been  in  this 
way  caught  in  a  trap,  since  any  foreign  solid  body, 
with  a  suitable  hole  in  it,  and  lodged  in  the  intes- 
tine, is  sure  to  attract  their  attention.  Thus  they 
have  been  strangled  by  metallic  buttons,  by  hooks 
and  eyes,  by  an  open  topped  thimble,  and  by  other 
foreign  bodies  accidentally,  or  even  purposely,  swal- 
lowed by  their  human  bearers. 

Though  I  cannot  dwell  at  greater  length  upon 
the  symptoms  and  pathological  effects  produced  by 
the  common  ascaris,  it  is  as  well  that  the  above 
facts  should  be  borne  in  mind.  In  various  obscure 
cases,  where  parasites  are  never  dreamt  of,  you  may 
sometimes  by  this  means  discover  the  true  cause  of 
what  hitherto  appeared  to  be  an  altogether  mysterious 
complaint.  In  cases  of  bleeding  from  the  lower 
bowel,  or  in  hsematemesis  and  haematuria,  always  be 
on  the  look  out  for  the  eggs  of  parasites.  On  the 
other  hand,  be  cautious  how  you  accept  the  notion  of 


ROUNDWORMS.  115 

parasitism,  for  without  fully  going  into  the  particulars 
of  any  given  case,  you  might  be  led  to  encourage  an 
erroneous  view  strenuously  urged  by  the  deluded 
patient.  An  estimable  and  amiable  member  of  the 
profession  once  consulted  me  in  reference  to  the 
presence  of  peculiar  worms  of  this  sort,  which  he 
believed  to  be  groping  about  beneath  his  skin  in 
every  direction,  and  I  have  encountered  other 
equally  curious  experiences,  some  of  which  will  be 
brought  forward  presently.  Probably  the  so-called 
lumbricus  is  more  frequently  suspected  to  be  present 
when  actually  absent  than  any  other  kind  of  human 
parasite,  because  when  once  a  single  worm  has 
come  away,  the  patient  or  "  bearer  '*  is  alarmed  by 
its  formidable  proportions,  and  is  therefore  constantly 
on  the  look  out  for  more  to  follow.  I  have  fre- 
quently been  called  upon  to  advise  in  such  cases, 
but  the  favourable  prognostications  which  I  have 
generally  held  out  to  the  persons  concerned  have 
not  in  all  instances  given  satisfaction.  A  few 
examples  may  be  quoted  in  illustration. 

CASE  LXVI. — M.S.  G., a  gentleman  under  middle 
age,  one  of  H.  B.  M/s  Consuls  from  the  East,  con- 
sulted me  in  the  spring  of  1866.  About  two  months 
previously  he  had  passed  a  small  Ascaris  lumbri- 
coides,  and  he  attributed  the  anomalous  nervous 
symptoms  from  which  he  was  still  suffering  to  the 
presence  of  other  lumbrici  left  behind.  He  assured 
me  that  he  was  free  from  Oxyurides,  and,  so  far  as 


116  LECTURES. 

he  knew,  he  had  never  been  attacked  by  any  other 
species  of  helminth.  Without  really  sharing  his 
suspicions  as  to  the  presence  of  more  ascaridcs,  I 
prescribed  three  successive  four-grain  doses  of  san- 
tonin, each  dissolved  in  half  an  ounce  of  castor  oil. 
In  this  way  I  hoped,  of  course,  not  only  to  test  for 
lumbricus,  but  also  in  the  event  of  a  negative  result 
to  satisfy  the  patient's  mind.  In  this  latter  respect 
I  believe  my  anticipations  were  fully  realized. 

CASE  LXVII. — B.  A.,  a  gentleman  residing  in 
London,  requested  my  opinion  on  the  23rd  March, 
1873.  He  had  nothing  particular  to  complain  of 
beyond  slight  indigestion ;  and  he  had  hitherto 
never  entertained  any  suspicion  respecting  the  pre- 
sence of  lumbrici.  However,  on  the  previous  day 
he  had  passed  an  Ascaris  lumbricoides  about  ten 
inches  in  length.  Having  explained  to  him  the 
unlikelihood  of  there  being  any  more  entozoa  to 
come  away,  I  ordered  a  few  compound  scammony 
powders  combined  with  santonin,  their  action 
being  increased  by  a  saline  aperient.  The  result 
was  not  communicated. 

CASE  LXVIII. — C.  B.,  an  infant  only  seven 
months  old,  was  brought  to  me  by  its  parents,  who 
could  only  attribute  the  child's  refusal  of  food  and 
sickliness  to  the  presence  of  parasites  ;  of  the  ex- 
istence of  which,  however,  they  admitted  they  had 
never  had  ocular  evidence.  The  father,  a  medical 
man,  practising  in  the  suburbs  of  the  metropolis, 


ROUNDWORMS.  117 

suspected  lumbrici,  but  I  saw  no  satisfactory  grounds 
for  that  assumption.  To  test  his  views  I  prescribed 
single-grain  doses  of  santonin,  and  a  simple  tonic 
containing  steel.  What  further  treatment  was 
adopted  I  do  not  know ;  but  had  the  result  been 
otherwise  than  negative  as  regards  the  parasites,  I 
should  certainly  have  been  informed. 

CASE  LXIX. — M.  B.,  a  lady  residing  in  Lon- 
don and  rather  advanced  in  years,  believes  herself 
to  be  the  victim  of  lumbrici.  Six  months  back 
she  passed  a  large  specimen  of  this  kind  of  worm ; 
and  as  she  is  still  subject  to  painful  sensations  in 
the  region  of  the  stomach  and  liver,  these  symp- 
toms, in  her  own  judgment,  can  only  be  attributable 
to  other  parasites  left  behind.  At  the  present  time 
the  pain  in  her  right  side  is  more  or  less  persistent, 
but  before  the  solitary  Ascaris  came  away  she 
suffered  much  more  considerably  from  nervous 
twitchings,  colicky  pains,  accompanied  with  occa- 
sional attacks  of  hsematemesis.  Here  again,  con- 
sidering the  fact  of  the  cessation  of  all  the  more 
marked  and  characteristic  symptoms,  I  doubted  the 
presence  of  lumbrici,  attributing  the  alleged  symp- 
toms partly  to  nervousness,  and  partly  to  a  rather 
free  use  of  stimulants.  Nevertheless,  as  is  my 
wont  in  such  cases,  I  tested  for  lumbrici  by  the 
administration  of  santonin  and  scammony  powders, 
followed  by  a  saline  cathartic.  No  worms  of  any 
kind  coming  away,  I  looked  more  closely  into  the 


118  LECTURES. 

possibilities  of  the  case,  and  found  she  was  really 
suffering  from  vesical  irritation.  On  this  account 
I  prescribed  a  buchu  mixture,  containing  bicar- 
bonate of  potash.  This  treatment  having  been 
continued  with  good  results  for  about  a  month,  I 
finally  advised  a  mineral  tonic ;  insisting  however, 
more  particularly,  on  the  better  observance  of 
certain  common-sense  rules  as  to  diet  and  drink. 

The  record  of  these  negative  cases,  if  I  may  so 
term  them,  is  not  without  instruction  ;  for  apart 
from  the  suggestions  conveyed  as  to  treatment 
they  set  forth  the  value  of  a  correct  diagnosis  and 
prognosis  alike.  In  one  or  two  instances  I  have 
certainly  been  deceived,  but  not  in  cases  of  the 
above  description.  Only  very  recently  I  treated  a 
case  of  supposed  threadworm  disease  with  the  fullest 
expectation  of  bringing  away  several  or  even  many 
parasites,  yet  in  this  instance  the  nervous  and  other 
symptoms  must  have  been  due  to  another  cause. 
Though  a  little  out  of  place,  I  think  the  case  ought 
to  be  recorded ;  and  you  will  at  once  see  whether 
or  not  I  was  justified  in  the  course  I  pursued. 

CASK  LXX. — T.  W.  A.,  a  gentleman  in  business 
and  residing  at  the  East-end  of  London,  visited  me 
on  the  18th  September,  1871.  He  has  been 
under  the  care  of  a  medical  gentleman  who  attri- 
buted his  symptoms  to  "  worms,"  and  who,  in  this 
view,  had  prescribed  male-fern,  but  without  any 
satisfactory  result.  Moreover,  to  suppress  any 


ROUNDWORMS.  119 

doubts  I  might  entertain  on  the  subject,  the  patient 
brought  me  a  parasite  which  he  had  just  passed, 
and  this  I  readily  determined  to  be  a  characteristic 
female  example  of  Oxyuris  vermicularis.  This  was 
a  sort  of  evidence  scarcely  to  be  resisted ;  but  it 
was  rather  weakened  by  the  fact  that  he  had 
observed  no  other  specimens  in  the  faeces.  When, 
however,  I  questioned  him  as  to  his  symptoms,  the 
correctness  of  the  surmise  of  his  usual  medical  adviser 
that  he  had  worms  seemed  to  gain  strength.  For 
years  past  he  has  been  getting  thinner  and  thinner, 
being  now  anaemic  and  emaciated.  His  appetite 
has  been  at  all  times  indifferent;  he  is  likewise 
extremely  nervous,  and  occasionally  disturbed  at 
night  by  unpleasant  dreams.  His  general  appea- 
rance was  that  of  a  man  gradually  reduced  by  some 
persistent  cause  of  internal  irritation;  and  there 
was  nothing  else,  apparently,  to  account  for  the  ill 
health  apart  from  parasitism.  Accordingly,  I 
thought  it  right  to  put  him  to  a  thorough  test,  and 
prescribed  charcoal  and  sulphur  powders,  followed 
by  ^viij  doses  of  the  Friedrichshall  mineral  waters. 
In  a  few  days  he  called  to  tell  me  that  the  aperient 
action  of  the  water  was  at  first  excessive,  but  it 
soon  gradually  decreased  in  power.  It  appeared 
nevertheless  to  have  had  a  sufficiently  fair  trial  for 
the  particular  purpose  held  in  view;  yet  no  more 
Oxyurides  were  observed.  Therefore,  discounte- 
nancing, provisionally  at  least,  the  further  use  of 


120  LECTURES. 

anthelmintics,  I  prescribed  a  tonic  (consisting  of 
perchloride  of  iron  with  infusion  of  calumba),  fully 
expecting  that  this  simple  treatment,  combined  with 
regulations  as  to  wine,  food,  and  exercise,  would 
eventually  prove  successful,  and  that  there  would 
be  no  occasion  to  repeat  the  apparently  useless 
vermifuges. 


LECTURE  XVII. 

Value  of  Santonin  in  Ascarides  or  Lumbrici — Trichiniasis  first 
discovered  in  the  Living  Subject  by  Zenker  —  Symptoms  of 
the  Trichinous  Disease — Recent  Outbreak  in  England — Home- 
fed  Swine  generally  free  from  this  Parasite — Dr.  Dickinson's 
published  Cases — His  Claims  as  being  the  First  Person  to 
recognise  and  treat  the  Disease  in  England  are  said  to  have 
been  disputed — Further  Explanation  required. 

GENTLEMEN,, — Here  I  must  draw  to  a  close  what 
I  have  to  say  respecting  the  commoner  forms 
of  nematode  entozoa,  only  adding  my  assurances 
as  to  the  value  of  santonin  in  the  treatment  of 
lumbrici ;  though,  as  I  have  repeatedly  stated 
before,  its  inefficacy  in  oxyurides  is  pretty  well 
proven.  As  an  instance  of  the  almost  specific 
action  of  santonin  in  Ascaris  lumbricoides,  I 
may  mention  the  interesting  circumstance  that 
on  one  occasion  a  man  passing  through  the  labo- 
ratory of  a  pharmaceutical  firm  in  the  City 
picked  up  a  santonin  lozenge  and  swallowed  it. 
During  the  following  night  or  morning,  to  the 
astonishment  of  his  wife,  he  passed  a  huge  lum- 
bricus,  which  had  thus  evidently  been  expelled  by 


122  LECTURES. 

the  action  of  a  single  grain  of  this  valuable  drug. 
The  medical  value  of  the  anecdote  is  further  in- 
creased by  the  fact  that  the  man  had  never  com- 
plained of  parasitism  of  any  kind,  nor  was  he  aware 
of  the  medicinal  character  of  the  sweetmeat.  No 
doubt  the  lumbricus  might  sooner  or  later  have 
proved  itself  to  be  a  troublesome  guest,  so  that  on 
the  whole  the  "host"  must  be  congratulated  on 
this  apparently  providential  interference  in  his 
favour. 

As  regards  the  rarer  forms  of  human  nematode 
parasites,  the  only  other  species  respecting  which  it 
is  necessary  that  I  should  say  a  few  words  is  the 
little  Trichina  spiralis.  I  have  so  fully  enlarged 
upon  the  history,  structure,  and  development  of 
this  entozoon  elsewhere  that  I  need  only  add  a  few 
particulars.  The  disease  produced  by  it  was  first 
discovered,  or  rather  diagnosed,  by  Professor  Zenker, 
of  Erlangen ;  but,  for  the  antecedent  discoveries  re- 
corded in  this  connexion,  and  also  for  a  correct 
knowledge  of  our  later  experimental  researches,  I 
must  refer  you  to  the  supplement  of  my  larger 
treatise  on  Entozoa.  In  my  smaller  book  on 
"  Tapeworms  and  Threadworms "  I  have  given  a 
concise  statement  of  the  practical  bearings  of  the 
subject;  but  as  this  volume  is  now  out  of  print, 
and  as  cases  have  recently  occurred  in  the  North 
of  England,  I  cannot  be  satisfied  with  merely  re- 
ferring you  to  what  I  have  there  said.  The  trichina, 


TLESHWOKMS.  123 

as  I  have  stated,  is  introduced  into  the  human 
body  by  the  ingestion  of  verminiferous  meat. 
"  When  the  parasites  are  taken  in  sufficient 
numbers  many  unpleasant  symptoms  show  them- 
selves in  the  infested  person.  There  is,  first  of  all, 
restlessness,  loss  of  appetite,  and  more  or  less  pros- 
tration. This  is  succeeded  by  rheumatoid  pains  in 
the  limbs,  with  the  frequent  accompaniment  of  con- 
siderable swelling.  The  pain  is  not  situated 
in  the  joints,  but  in  the  intermediate  soft  parts. 
In  severe  cases  the  limbs  are  drawn  up  and 
half  bent,  as  in  instances  of  severe  and  con- 
tinued cramp.  Sometimes  the  suffering  is  ex- 
cruciating, and  even  unbearable;  patients  having 
been  known  to  request  the  surgeon  to  put  an 
end  to  their  lives.  In  the  worst  forms  of  the 
malady  death  rapidly  ensues  from  diarrhrea  and 
exhaustion. 

"  When  once  the  parasite  has  gained  admission 
to  our  muscles,  all  hopes  of  destroying  it  are  at  an 
end ;  but  if  a  person  suspects  himself  to  have 
eaten  diseased  or  trichinized  meat  he  should  lose  no 
time  in  seeking  assistance.  Immediate  advice,  fol- 
lowed by  a  suitable  anthelmintic,  might  be  the 
means  of  saving  his  life,  whereas  a  few  days'  delay 
would  perhaps  prove  fatal.  Whilst  the  worms  are 
in  the  intestinal  canal  we  can  get  rid  of  them ; 
but  when  once  the  trichinal  brood  have  migrated 
into  the  flesh  we  have  no  means  of  expelling 


124  LECTURES. 

them.  In  had  cases  of  capsuled  trichina,  if  the 
system  is  properly  supported,  patients  will  recover 
who  otherwise  would  undoubtedly  have  perished. 
Various  drugs  have  been  administered,  but  at  this 
stage  they  have  failed  to  effect  any  good.  I  have 
no  faith  in  the  picro-nitrate  of  potash  or  other 
vaunted  remedies.  They  have  probably  done  more 
harm  than  good ;  for  it  should  be  borne  in  mind  that 
any  drug  sufficiently  powerful  to  poison  this  ento- 
zoon  could  scarcely  fail,  when  introduced  into  the 
human  body,  to  act  injuriously  upon  the  bearer. 
The  great  point  is,  in  bad  cases,  to  support  the 
system  at  all  hazards.  In  the  early  stage  of  the 
malady,  before  the  embryos  have  commenced  mi- 
grating, all  the  parasites  may  be  dislodged  and 
serious  consequences  be  prevented.  It  should  be 
borne  in  mind,  moreover,  that  the  unpleasant 
symptoms  do  not  show  themselves  until  at  least  a 
week  has  elapsed  since  the  ingestion  of  the  diseased 
meat ;  that  is  to  say,  at  a  period  corresponding  to 
the  birth  and  development  of  the  migrating  pro- 
geny." 

In  England,  until  very  lately,  no  case  of  trichi- 
niasis  had  been  recognised  in  the  living  human 
subject.  It  is  true  that  trichinae  have  been  ob- 
served, after  death,  in  at  least  thirty  separate  in- 
stances ;  several  of  these  trichinized  subjects  having 
been  examined  by  myself.  Into  our  experimental 
inquiries  on  this  head  I  do  not  propose  to  enter ; 


FLESH  WORMS.  125 

but  I  may  observe  that  they  have  led  myself  and 
others  to  the  practical  conclusion  that  whereas,  on 
the  one  hand,  persons  should  avoid  eating  the  im- 
perfectly cooked  flesh  of  mammals  of  all  kinds, 
they  need  not,  on  the  other  hand,  abstain  from 
swallowing  the  flesh  of  birds  and  fish,  since 
the  latter  may  be  eaten  raw  with  perfect  im- 
punity— at  least,  in  so  far  as  these  entozoa  are 
concerned,  The  introduction  of  prepared  meats 
from  the  Continent  is  a  constant  source  of  danger, 
especially  if  precautions  as  to  cooking  are  not 
taken.  At  home,  our  swine  are  singularly  free 
from  this  parasite,  and  the  same  may  be  said  of  the 
flesh  of  our  other  domesticated  mammalia.  There 
is  thus  little  likelihood  of  the  disease  becoming 
prevalent  amongst  us ;  nevertheless  the  recent  out- 
break of  trichiniasis  in  Cumberland  should  suggest 
caution. 

The  circumstances  connected  with  this  outbreak 
I  have  already  made  known  in  the  pages  of  the 
British  Medical  Journal,  and  also  subsequently  in 
my  Cantor  Lectures  delivered  before  the  Society  of 
Arts,  and  published  in  their  admirably  conducted 
journal.  I  do  not  propose  to  recapitulate  the 
facts,  but  I  may  observe  that  the  three  persons  at- 
tacked had  been  feeding  on  the  flesh  of  a  sow  of 
their  own  rearing.  The  man-servant,  who  natu- 
rally ate  most  heartily,  suffered  most,  and  I  made 
a  calculation  that  he  must  have  played  the  part  of 


126 


LECTURES. 


"  host "  to  some  forty  millions  of  these  minute  pa- 
rasites. Dr.  William  Lindow  Dickinson,  of  Work- 
ington,  who  first  sent  me  some  of  the  flesh  for 
determination,  has  himself  published  a  brief  account 
of  the  cases  in  the  columns  of  the  British  Medical 
Journal.  I  wish  therefore  to  state,  emphatically, 
my  belief  that  Dr.  Dickinson  was  the  first  person 
to  observe,  recognise,  and  treat  the  disorder  in 
the  United  Kingdom,  and  that  up  to  the  pre- 
sent date  (November,  1871)  I  am  not  aware  that 
any  other  English,  Scotch,  or  Irish  physician 
or  surgeon  has  ever  encountered  any  case.  If  I 
lay  stress  upon  this  statement  it  is  because  I  have 
learned  from  Dr.  Dickinson  himself  that  at  least 
one  other  person  has  asserted  his  priority  in  this 
relation,  and  I  should  like  to  see  the  matter  cleared 
up  by  a  reference  to  any  published  record  proving 
their  prior  experiences  in  the  matter.  Sir  Dominic 
Corrigan  is  stated  to  have  told  a  gentleman  in  the 
House  of  Gommons  "  that  he  had  often  met  with 
trichiniasis  in  his  practice  in  Dublin/'  further 
averring,  moreover,  that  the  disease  "  was  quite 
common  in  many  parts  of  Ireland/'  If  Sir  D. 
Corrigan  merely  wished  his  friend  and  others  to 
understand  that  he  has  repeatedly  encountered  the 
trichina  at  post-mortem  examinations,  then  there  is 
nothing  surprising  in  his  statements  ;  but  if,  on  the 
other  hand,  the  disease  itself  has  been  frequently 
recognised  in  the  living  Irish  subject,  I  can  only 


FLESHWORMS.  127 

express  my  astonishment  that  hitherto  we  have 
heard  little  or  nothing  about  it.  It  may  be  that 
our  Irish  brethren  have  been  too  modest  to  place 
such  valuable  experiences  on  record ;  and  if  that 
be  the  case  they  must  not  blame  us  for  deliberately 
refusing,  in  the  present  state  of  our  knowledge — or, 
mayhap,  of  our  ignorance — to  accord  to  them  their 
otherwise  legitimate  credit  of  priority. 


LECTURE   XVIII. 

Imaginary  or  Spurious  Instances  of  Parasitism— Pseudhelminths 
sometimes  Real — Bots,  Maggots,  and  other  Larvae  of  Insects — 
These  Cases  often  connected  with  Hysteria— Canes  LXXI.  to 
LXXV. 

GENTLEMEN, — Tempting  as  this  subject  of  trichina 
is,  I  cannot  longer  dwell  upon  it,  nor  upon  the 
other  forms  of  nematode  parasites  which  are  only 
rarely  encountered  in  actual  practice.  In  truth,  it 
is,  after  all,  a  thorough  knowledge  of  the  commoner 
forms  of  parasitism  which  you  most  jequire,  and 
it  is  on  that  account  that  I  purposely  dwell  only 
very  briefly  on  the  obscurer  forms  of  helminthiasis. 
Whilst  recording  the  previous  cases  I  dare  say  you 
will  have  remarked  that  a  large  proportion  of  these 
alleged  sufferers  from  tapeworm,  threadworm,  and 
round  worm  were  altogether  under  a  delusion.  Of 
these,  several  had  at  some  time  or  other  been 
plagued  with  parasites,  and  had  got  rid  of  their 
enemies  without  being  aware  of  it,  whilst  others 
were  deluded  from  the  beginning.  On  the  other 
hand,  my  experiences  have  shown  or  confirmed 
what  many  of  you  probably  knew  well  enough 
before,  that  not  a  few  people  go  about  with  en- 


SPURIOUS  WORMS.  129 

tozoa  in  their  interior  without  ever  so  much  as 
dreaming  of  their  presence.  Again,  as  regards  a 
whole  group  of  other  creatures,  which  I  have  else- 
where called  pseudhelminths,  you  must  be  prepared 
for  all  sorts  of  odd  statements  and  persistent  as- 
surances. In  some  cases  the  pseudhelminths  are 
veritable  creatures,  such  as  bots,  maggots,  and  all 
sorts  of  insect  larvae ;  whilst  in  others  the  morbid 
imagination  alone  has  had  to  do  with  the  patient's 
distress.  Some  of  these  forms  of  affliction  are 
amongst  the  most  troublesome  and  vexatious  ma- 
ladies with  which  any  physician  can  have  to  deal  j 
nevertheless,  in  one  or  two  instances  the  hap- 
piest results  have  attended  the  mere  delivery 
of  an  honest  opinion.  The  record  of  one  or 
two  of  these  unrealities  will  probably  excite  your 
astonishment — at  least,  they  are  likely  to  appear 
strange  to  those  of  you  who  have  not  already 
paid  attention  to  the  phenomena  of  hysteria  and 
other  allied  nervous  affections.  If  the  following 
cases  cannot  be  said  to  be  entirely  unique,  they 
are  not  on  that  account  the  less  devoid  of  in- 
struction : — 

CASE  LXXI. — R.  E.,  an  elderly  lady,  resident  in 
London,  sought  my  advice  in  November,  1866. 
Mentally  troubled  by  some  misfortune,  she  had 
taken  up  the  notion  that  she  was  harbouring  a 
truly  formidable  parasite,  the  creature  in  question 
giving  rise  to  all  sorts  of  strange  feelings,  especially 


130  LECTURES. 

in  the  region  of  the  throat.  At  times  she  was 
even  tempted  to  think  that  this  mysterious  ento- 
zoon  might  turn  out  to  be  that  undesirable  hel- 
minth called  in  biblical  phraseology  "  the  worm 
that  dieth  not."  Having  assured  her  that  the 
awful  parasite  to  which  she  referred  was  quite 
unknown  to  helminthologists,  I  nevertheless  en- 
couraged her  to  think  that  we  should  dislodge  any 
other  species  of  worm  which  might  happen  to  be 
present.  Accordingly,  I  prescribed  an  aperient, 
containing  at  the  same  time  three  grains  of  san- 
tonin to  each  dose.  As  luck  would  have  it,  the 
medicine  produced  considerable  nausea  and  sick- 
ness, resulting  in  the  passage  by  the  mouth  of  a 
number  of  fine  filaments  more  or  less  resembling 
minute  worms.  These  threads  were  carefully  col- 
lected and  brought  to  me  in  an  envelope,  and  on 
my  submitting  them  to  microscopic  examination 
they  turned  out  to  be  portions  of  variously  coloured 
wool.  Having  explained  to  my  patient  that  the 
presence  of  these  foreign  substances,  when  lodged 
in  the  neighbourhood  of  the  fauces  would  suffi- 
ciently account  for  the  tickling  and  other  disagree- 
able sensations  she  complained  of;  and  having  also 
further  assured  her  that  there  were  no  other 
parasites  capable  of  producing  her  particular 
symptoms,  she  expressed  herself  as  being  entirely 
satisfied,  her  manner  at  the  same  time  showing 
that  the  mind  was  greatly  relieved.  The  further 


SPURIOUS  WORMS.  131 

recommendation  of  a  suitable  tonic,  with  ad- 
vice as  to  diet,  completed  the  case,  which  was 
certainly  that  of  a  perfect  cure  under  very  peculiar 
circumstances. 

CASE  LXXII. — H.  M.,  a  middle-aged  unmarried 
lady,  from  Oxfordshire,  consulted  me  in  the  spring 
of  1867.  She  believed  herself  to  be  the  victim  of 
worms,  and  was  quite  sure  that  she  passed  great 
numbers  of  them  continually.  None  of  the  forms 
she  described  appeared  to  me  to  answer  to  any 
genuine  species  of  entozoon ;  but  it  will  surprise  no 
one  to  learn  that  my  repeated  assurances  to  that 
effect  only  excited  astonishment,  not  so  say  con- 
tempt. Here,  again,  to  satisfy  a  deluded  patient, 
I  prescribed  santonin  in  combination  with  podo- 
phyllin,  each  powder  being  followed  by  two-drachm 
doses  of  the  liquid  extract  of  senna,  and  of  course 
I  naturally  insisted  upon  having  an  opportunity 
afforded  me  of  examining  any  entozoa  which  might 
come  away.  Surely  enough,  at  a  subsequent 
visit,  the  patient  produced  abundant  examples 
of  the  so-called  parasites,  and  I  was  enabled  to 
explain  to  her  that  the  worms  in  question  were 
characteristic  specimens  of  strawberry  seeds.  In 
this  case,  however,  no  symptoms  of  gratitude  or 
pleasure  on  the  sufferer's  part  followed  my  an- 
nouncement, the  parasitic  delusion  immediately 
assuming  another  shape. 

CASE  LXXIII. — C.  D.,  an  elderly  unmarried  lady, 

K2 


132  LECTURES. 

from  Pembrokeshire,  is  certain  that  she  is  a  martyr 
to  worms,  from  which  she  has  suffered  for  years, 
as  her  medical  advisers,  if  I  asked  them,  would  be 
ready  to  testify.  That  she  had  been  well  phy- 
sicked there  could  not  be  the  slightest  doubt,  for 
she  seemed  to  have  tasted  almost  every  drug  in  the 
Pharmacopoeia.  Amongst  the  various  medicines 
she  had  swallowed — to  say  nothing  of  the  turpen- 
tine and  other  remedies  introduced  as  enemata — 
she  certainly  named  ammonia,  aloes,  assafoetida, 
gentian,  quassia,  sulphur,  potash,  taraxacum,  va- 
lerian, hyoscyamus,  senna,  santonin,  male-fern,  and 
quantities  of  mercury.  That,  under  these  circum- 
stances, she  should  be  so  well  as  she  now  appeared 
was  in  itself,  I  thought,  noteworthy.  On  closely  ques- 
tioning her,  I  felt  bound  to  admit  that  at  one  time 
or  other  she  must  have  had  lumbrici ;  but  when  I 
saw  her,  which  was  in  November,  1867,  the  pains 
she  complained  of  were  clearly  referable  to  rheu- 
matism and  gout,  and  there  was  no  evidence  that 
she  was  suffering  from  parasites  of  any  kind.  In 
accordance  with  her  wishes,  I  prescribed  an  anthel- 
mintic  (containing  santonin),  but  the  result,  as  I 
anticipated,  was  equally  negative  a.rid  unsatis- 
factory. / 

CASE  LXXIV.— J.  M.,  a  titled  lady,  residing  in 
Belgravia,  was  seen  by  me  in  consultation  with  her 
usual  medical  attendant.  Suffering  from  hysteria 
and  ennui,  she  attributed  her  obscure  pains  to 


SPURIOUS  WORMS.  133 

the  presence  of  minute  living  parasites,  which 
she  alleged  to  be  constantly  passing.  Un- 
doubtedly there  was  vesical  irritation,  with  uterine 
disturbance.  Several  of  these  so-called  worms 
having  been  placed  in  a  bottle  of  water  and  sub- 
mitted to  my  scrutiny,  I  at  once  referred  them  to 
certain  well-known  forms  of  Infusoria ;  the  more 
conspicuous  species  being  Cypris  tristriata  and 
Bursaria  vulgaris.  It  was  evident  to  my  mind 
that  these  pseudhelminths  had  neither  passed  from 
the  bowel  nor  from  the  urethra,  and  that  the  case 
was  therefore  either  one  of  intentional  deception,  or, 
more  probably,  of  unintentional  self-deception.  On 
the  latter  supposition  I  sought  to  explain  the  acci- 
dental introduction  of  water  containing  these  crea- 
tures into  the  night-stool,  but  suggestions  of  this 
kind  led  to  no  satisfactory  explanation.  To  allay 
the  vesical  irritation  and  evident  nervous  irrita- 
bility I  prescribed  buchu,  hyoscyamus,  and  small 
doses  of  steel.  I  also  advised  a  change  of  scene  ; 
likewise  the  avoidance  of  late  hours  and  excessive 
visiting.  This  advice  gave  disappointment ;  the 
one  thing  needful,  in  the  patient's  mind,  at  least, 
being  the  administration  of  a  good  vermifuge. 
From  what  I  subsequently  heard  I  have  little  doubt 
that  the  case  was  one  of  unintentional  self-deception. 
It  is  unpleasant,  of  course,  to  demand  that  patients 
should  be  watched  in  order  to  find  out  how  ento- 
mostracous  crustaceans,  water-fleas,  and  other  ani- 


134  LECTURES. 

malcules,  are  thus  introduced  into  their  night- 
stools  ;  but  a  professional  friend  to  whom  I  have 
since  mentioned  this  case  has  advised  such  a  step. 

CASE  LXXV. — A.  F.  D.,  a  gentleman  from 
Worksop,  called  in  November,  1870,  stating  that  he 
was  suffering  from  ^ot^.  He  did  not  look  like  a 
person  in  ill  health ;  neither  did  the  case  offer  any 
symptoms  worth  noting.  He  could  only  be  said  to 
be  labouring  under  a  slight  attack  of  dyspepsia. 
As,  however,  he  insisted,  pertinaciously  enough,  upon 
the  existence  of  bots  in  his  interior — and  he  had 
been  professionally  informed  that  he  had  undoubt- 
edly passed  bots — I  prescribed  powders  containing 
santonin,  calomel,  and  scammony.  I  particularly 
requested  that  any  specimens  which  passed  should 
be  sent  to  me ;  and  on  the  2nd  of  the  following 
January  I  received  a  phial  containing  eleven  of 
these  alleged  parasites.  To  the  naked  eye,  it  must 
be  admitted  that  these  foreign  bodies  did  more  or 
less  resemble  the  larvae  of  restrus.  They  varied  in 
size  up  to  seven-tenths  of  an  inch,  and,  with  one 
exception,  were  of  a  yellow  colour.  Further  ex- 
amination showed  that  the  exceptional  specimen 
was  only  an  undigested  and  entire  raisin,  retain- 
ing its  pulp  cells  and  numerous  crystals ;  whilst 
all  the  other  bot-like  bodies  were  only  undi- 
gested masses  of  imperfectly  cooked,  waxy  pota- 
toes. The  cells,  varying  from  l-140th  to  l-80th 
of  an  inch  in  length,  gave  the  usual  purple 


SPURIOUS  WORMS.  135 

reaction  on  the  addition  of  iodine.  In  accor- 
dance with  this  evidence  I  finally  advised  as  to 
food,  habits,  and  drink — especially  insisting  upon 
the  avoidance  of  strong  spirits — which  I  suspected 
were  almost  the  only  cause  of  the  impaired  digestive 
functions. 


LECTURE  XIX. 

Bots  from  the  Human  Intestinal  Canal — Difficulties  may  arise  as  to  the 
means  of  distinguishing  Genuine  from  Spurious  Cases — Maggots 
may  lodge  beneath  the  Skin— Cases  LXXVI.  to  LXXVIIL— 
The  Larvae  of  Flies  may  give  rise  to  disagreeable  Symptoms — 
Cases  LXXIX.  to  LXXX.— The  Harvest  Bug  and  the  Gigger. 

GENTLEMEN, — At  this  point  I  may  mention  that 
numerous  instances  of  insect  larvae  occurring  in 
the  human  intestines  have  from  time  to  time  been 
brought  under  my  notice  ;  and  I  have  also  to  record 
the  fact  that  such  creatures  occasionally  take  up 
their  abode  beneath  the  skin.  I  now  show  you  a 
specimen  of  human  hot  which  I  received  from  Mr. 
Alfred  Higginson,  of  Liverpool ;  and  in  the  College 
of  Surgeons  you  will  see  a  small  insect  larva  which 
was  presented  to  me  by  Dr.  Kirk,  who  had  removed 
it  from  Dr.  Livingstone's  leg  whilst  they  were 
travelling  together  in  Africa.  Through  the  kind- 
ness of  friends  I  have  obtained  a  great  variety  of 
spurious  worms  of  this  sort,  and  of  other  pseudhel- 
minths,  some  of  which  undoubtedly  were  parasitic, 
whilst  others  were  erroneously  interpreted  to  be 
such.  In  truth,  it  is  not  always  easy  to  decide  ;  at 
least  a  correct  diagnosis  is  difficult  when  you  can 


SPURIOUS  WORMS.  137 

only  get  at  a  garbled  or  imperfect  statement  of  the 
facts.  Here  are  three  more  maggot  cases,  all  of 
which  are  probably  genuine  : — 

CASE  LXXVI. — C.  D.  P.,  a  physician  residing  at 
the  West  End  of  London,  called  upon  me  on  the 
18th  of  January,  1868,  bringing  for  my  inspection 
and  determination  a  parasite  which  he  assured  me 
had  been  removed  from  the  arm  of  a  lady  of 
rank.  To  be  more  precise,  I  understood  him  to 
say  that  it  had  been  expelled  from  a  boil  situated 
in  the  immediate  neighbourhood  of  the  wrist-joint. 
On  examining  this  pseudhelminth,  I  perceived  that 
it  was  only  an  ordinary  caterpillar,  referable  to  one 
or  other  of  the  numerous  species  of  Noctuida.  It 
was  not  unlike  that  of  the  common  gooseberry 
moth.  However,  my  opinion  having  been  requested 
(in  a  thoroughly  professional  and  proper  way)  in 
reference  to  the  possible  mode  of  introduction  of 
this  parasite,  I  at  first  felt  obliged  to  assert  my 
doubts  as  to  the  accuracy  of  his  statements.  After- 
wards, however,  my  opinion  was  somewhat  shaken 
when  he  positively  assured  me  that  he  had  himself 
pressed  one  of  the  specimens  from  the  interior  of 
the  boil.  Provisionally  accepting  this  view  as  a 
possible  explanation,  I  suggested  the  employment 
of  a  camphor  liniment,  in  view  of  preventing  any 
recurrence  of  the  maternal  insects'  attacks,  or 
rather  of  any  species  of  insect  resembling  the  sup- 
posed original  offender  ;  and  it  is  so  far  satisfactory 


138  LECTURES. 

to  know  that  nothing  of  the  kind  recurred.  We 
must,  of  course,  be  always  on  our  guard  lest  we 

1  infer  that  the  maggots  occasionally  found  on  re- 
moving bandages  have  necessarily  proceeded  from 
the  diseased  or  injured  parts. 

CASE  LXXVIL— H.  H.  G.,  a  spare  and  highly 
nervous  young  man  from  the  East  End  of  London, 
called  on  me  on  the  1  Ith  of  September,  1869.  He 
brought  with  him  a  very  peculiar  looking  insect 
larva,  specimens  of  which  he  alleged  were  constantly 
passing  from  him  by  the  lower  bowel.  He  be- 
lieved, I  fear  correctly  enough,  that  the  severe 
symptoms  from  which  he  was  suffering  were  entirely 
due  to  the  presence  of  these  parasites ;  but  he  de- 
clined to  let  me  prescribe  for  him.  His  manner, 
appearance,  and  style  of  address  betokened  extreme 
irritability  and  sensitiveness,  and  he  told  me  that 
he  was  subject  to  epileptiform  seizures.  His  exces- 
sively agitated,  hurried,  and  anxious  manner,  pre- 
vented my  gathering  any  other  particulars,  but  the 
impression  I  received  was  to  the  effect  that  these 
pseudhelminths  were  the  sole  cause  of  his  sufferings. 
I  have  mislaid  the  parasite,  which  I  believe  to  have 
been  the  larva  of  an  Anthomyia. 

CASE  LXXVIIL— E.  D.  W.,  aged  sixty,  residing 
in  Newport,  Monmouthshire,  informed  me  by  letter 
that  he  had  passed  several  worms,  the  nature  of 
which,  his  medical  friends  tell  him,  "  is  unknown." 
He  is  very  much  out  of  health,  but  is  in  doubt  as 


SPURIOUS  WORMS.  139 

to  the  real  cause  of  his  sufferings.  His  illness 
commenced,  he  says,  with  pain  over  the  epigastric 
region,  followed  by  diarrhoea.  When  he  visited 
me,  on  the  28th  of  September,  1871,  I  perceived 
that  there  was  a  strong  pulsation  (as  if  from  an 
aneurism  al  tumour)  over  the  epigastrium  ;  and  on. 
this  account  he  afterwards  consulted  Dr.  Mur- 
chison.  To  what  extent,  however,  the  parasites 
contributed  to  his  symptoms  it  was  impossible  to 
say.  My  impression  is  that  the  diarrhoea  was  in 
part  due  to  them,  and  that  the  prostration  of 
which  he  complained  was  not  solely  attributable 
to  the  heart  affection  from  which  he  was  at  the 
same  time  suffering.  As  many  of  the  disagreeable 
symptoms  had  disappeared  since  the  passage  of  the 
worms,  I  forbad  the  employment  of  any  active 
anthelmintics,  except  in  the  event  of  their  return, 
or  of  a  suspicion  that  there  were  any  more  parasites. 
Five  or  six  were  passed  in  all ;  and  those  which  I 
received  were  characteristic  examples  of  the  larvae 
of  Anthomyia  canalicularis. 

The  presence  of  these  insect  larvae  is  by  no  means 
harmless,  and  I  believe  that,  in  proportion  to  their 
number  and  size,  they  give  rise  to  more  irritation 
than  the  ordinary  forms  of  intestinal  worms,  pro- 
perly so  called.  Numerous  instances  of  the  occur- 
rence of  the  larvae  of  flies  in  the  human  intestines 
have  come  before  me;  but,  fortunately  for  the 
bearers,  they  rarely  existed  in  any  considerable 


140  LECTURES. 

numbers.  Armed,  as  most  of  them  are,  with 
sharp  bristles,  or  stiff  hairs,  their  active  movements 
in  the  intestinal  canal  could  hardly  fail  to  be 
productive  of  serious  mischief.  Occasionally,  one 
meets  with  the  dead  eggs  of  the  common  flesh-fly 
in  the  faeces,  these  having  been  swallowed  acci- 
dentally at  table  after  they  had  been  thoroughly 
cooked  along  with  the  joint  on  which  the  parent 
insect  had  deposited  them.  The  larvae  of  Diptera 
are  usually  passed  alive ;  and  three  particular 
examples,  which  Dr.  Wilson  Fox  kindly  sent  me  in 
a  pill-box,  assumed  their  imago  condition  some  time 
after  they  had  been  placed  in  my  cabinet.  I  hope 
at  no  distant  day  to  unravel  some  more  of  the 
mysteries  connected  with  the  occurrence  of  these 
spurious  parasites  in  the  human  body,  but  I  can 
assure  you  that  the  subject  is  surrounded  by  many 
difficulties.  In  this  connexion  I  will  only  record 
two  other  allied  cases,  as  I  must,  for  the  present  at 
least,  bring  my  remarks  to  a  close. 

CASE  LXXIX.— J.  H.  W.,  a  distinguished 
clergyman,  rather  beyond  middle  age,  requested  my 
advice  respecting  certain  injuries  received  from  the 
bite  of  the  common  harvest-bug  (Leptus  autumnalis). 
That  these  bites  were  not  trifling  may  be  gathered 
from  the  fact,  that  their  poisonous  effects  had 
resulted  in  the  formation  of  three  large  boils  on  the 
surface  of  the  abdomen.  Their  inflamed  look 
bespoke  severe  irritation  at  the  surface,  whilst  as  a 


SPURIOUS  WORMS.  141 

consequence  other  symptoms  had  set  in,  such  as 
anorexia,  with  disturbed  sleep,  producing  a  general 
loss  of  health.  For  internal  administration  I 
ordered  a  vegetable  tonic  and  mild  aloetic  pill ;  the 
inflamed  bites  being  ordered  to  be  kept  constantly 
moist  with  Goulard  lotion.  Lint  thus  soaked,  and 
covered  with  oil-silk,  was  applied  over  the  entire 
abdominal  surface.  Under  this  simple  but  effective 
treatment  the  boils  rapidly  disappeared,  and  after  a 
while  the  general  health  itself  was  thoroughly  re- 
established ;  partly  I  believe  in  consequence  of  the 
subsequent  changes  and  additions  in  the  tonic 
treatment  which  I  had  found  necessary.  I  bring 
forward  this  case  as  being  the  only  instance  in 
which  I  have  myself  witnessed  any  marked  consti- 
tutional disturbance  following  the  bite  of  the 
harvest-bug.  Personally,  I  can  testify  to  the 
excessive  irritation  caused  by  the  bites  of  this 
insect. 

CASE  LXXX. — H.  S.  J.,  a  married  person, 
about  fifty  years  of  age,  consulted  me  in  the  autumn 
of  1869.  When  living  in  the  West  Indies  she  had 
suffered  severely  from  the  bites  and  lodgment  of 
the  gigger  or  chigoe  in  her  feet;  unfortunately, 
also,  she  still  retains  the  belief  that  either  the 
original  insects  or  their  progeny  are  'still  lodged 
beneath  the  skin.  On  examining  her  feet  I  found 
them  scarred  all  over  with  minute  incisions.  These 
it  seems  she  had  recently  inflicted  upon  herself, 


142  LECTURES. 

and  certainly  without  any  sufficient  reason,  for 
beyond  the  evidence  of  slight  impetiginous  ulcera- 
tions  there  were  no  indications  of  disease,  much  less 
of  parasitism.  I  prescribed  a  carbolic  acid  and 
glycerine  wash,  which  I  directed  to  be  applied 
every  morning  and  evening,  after  the  feet  had  been 
well  bathed  with  warm  water.  I  also,  of  course, 
endeavoured  to  put  a  stop  to  the  practice  of  har- 
pooning. At  the  expiration  of  a  week  I  had  the 
satisfaction  of  observing  that  the  scars  and  old 
impetiginous  sores  had  nearly  disappeared ;  never- 
theless she  could  not  be  persuaded  to  abandon  the 
notion  that  the  giggers  were  still  occupying  their 
old  abode. 


LECTURE  XX. 

Flukes  or  Trematode  Parasites  are  comparatively  rare  in  Man — 
The  Billiarzia  httmatobia  forms  a  Notable  Exception — Formi- 
dable nature  of  the  Disease  thus  Produced — The  Ciliated  Larvae  of 
this  Entozoon  display  a  Complicated  System  of  Aquiferous 
Vessels — Case  LXXXI. — Comments  on  the  Peculiarities  of  the 
Disease,  with  an  Exposition  of  the  Principles  which  should  guide 
us  in  the  Treatment  of  Cases. 

GENTLEMEN, — The  last  form  of  helminthiasis  which 
I  propose  to  bring  under  your  notice,  is  that  arising 
from  the  presence  of  flukes  in  the  human  body. 
It  is  a  fortunate  circumstance  that  the  disorders 
caused  by  trematode  parasites  are  comparatively 
rare ;  at  least  they  are  so  in  European  countries, 
and  especially  in  our  own  islands.  In  Africa, 
however,  the  case  is  far  otherwise,  as  I  shall  imme- 
diately show  you.  Of  the  nine  so-called  species  of 
fluke  recognised  as  human  entozoa,  four  have  only 
been  once  observed ;  another  has  been  twice  or 
thrice  noticed;  yet  another  three  times,  and  one 
other  on  four  occasions  ;  whilst  the  so-called  sheep- 
fluke  (Fasciola  hepaticd)  has  occurred  about  twenty 
times  in  all.  There  is  one  fluke  worm,  indeed, 
of  terrible  importance,  inasmuch  as  its  entrance  into 


V 


144  LECTURES. 

e  human  body  not  unfrequently  produces  a 
severe  and  even  fatal  hsematuria.  I  allude  to  the 
Bilharzia  hamatobia,  genetically  thus  named  by  me 
in  honour  of  its  original  discoverer.  This  parasite  is 
so  prevalent  in  Egypt  that  Dr.  Bilharz  of  Cairo  has 
expressed  his  belief  that  nearly  half  the  adult  in- 
habitants of  that  country  are  infested  by  it ;  and 
we  now  know  from  subsequent  investigations  that 
this  parasite  is  only  rather  less  abundant  in  Natal, 
cases  having  also  occurred  at  the  Cape,  and  in  the 
Mauritius.  My  acquaintance  with  this  remarkable 
entozoon  dates  as  far  back  as  the  4th  of  December, 
185 7,, when  I  discovered  a  solitary  specimen  in 
blood  that  had  escaped  from  the  portal  vein  of  an 
African  monkey  which  had  died  at  the  Zoological 
Society's  Menagerie,  Regent's  Park. 

Since    the    original    discoveries    and    researches 

made  by  Bilharz  and  Griesinger,   several  cases   of 

this  formidable  helminthiasis  have  been  brought  to 

the    notice    of    physicians    in   this    country.     Dr. 

John    Harley   recorded  the    first    case    recognised 

in  this  country  in  January,  1 864 ;    and  altogether  I 

lave  heard  of  certainly  not  less   than  six  separate 

nstances   where   colonists    (or    other    persons  who 

lave   previously  visited  the  infected  districts)  have 

come    to    England    with    the    disease   upon    them 

more  or  less  strongly  pronounced.     For  a  general 

description  of  the  worm,  together  with  a  condensed 

account  of  the  symptoms  and  diseased  appearances 


BLOODWORMS.  145 

this  parasite  produces,  I  must  refer  you  to  my 
larger  Treatise,  and  also,  more  particularly,  to  the 
standard  works  of  Leuckart  and  Kuchenmeister. 
You  will  also  gain  some  interesting  information 
from  Dr.  Harley's  contributions  to  the  Medico- 
Chirurgical  Society.  The  complete  developmental 
history  of  this  entozoon  remains  to  be  cleared  up ; 
but  I  take  this  opportunity  of  mentioning  that  I 
have  already  observed  the  development  of  the 
larvae  of  Bilharzia  up  to  the  stage  at  which  they 
display  a  remarkable  subcutaneous  water-vascular 
system.  The  results  of  my  investigations  I  hope 
shortly  to  publish  at  greater  length  ;  but  I  may  add 
that  a  brief  notice  of  the  principal  points  observed 
has  already  been  recorded  in  the  Report  of  the  Pro- 
ceedings of  the  Meeting  of  the  British  Association 
held  at  Liverpool  in  1870.  As  it  is  not  improbable 
that  many  more  cases  are  likely  to  come  to  the 
notice  of  the  profession  in  this  country,  I  am  glad 
to  be  able  to  bring  before  you  the  facts  of  one  very 
interesting,  and  in  some  respects  unique,  case,  which 
has  occurred  in  my  own  practice.  This  example 
will  serve  to  illustrate  certain  points  in  the  early 
history  of  the  disease,  and  it  will  also,  I  hope,  be 
instructive  in  reference  to  the  questions  of  diagnosis, 
prognosis,  and  the  most  correct  methods  of  treat- 
ment. 

CASE  LXXXL— G.  I.  G.,  a  little  girl,  seven  years 
of  age,  came  to  England  from  Natal,  with  her  parents. 


146  LECTURES. 

in  the  month  of  May,  1870 ;  and  I  first  saw  her  on 
the  22nd  of  July  of  that  year.  She  was  suffering 
from  haematuria,  the  first  indications  of  the  disease 
having  been  noticed  about  a  twelvemonth  previously. 
Though  by  nature  a  remarkably  strong  and  healthy 
child  her  strength  had  gradually  declined;  the 
prostration,  however,  being  more  marked  during  the 
warmer  months.  She  complained  but  little;  yet 
her  parents  and  nurse  observed  that  she  frequently 
showed  that  she  suffered  pain  during  or  at  the  close 
of  the  act  of  micturition.  She  had  been  treated 
for  urinary  parasites  by  the  family  physician ;  and 
the  true  nature  of  the  helminthiasis  appears  to 
have  been  fully  determined  by  Dr.  J.  Vacy  Lyle. 
In  a  letter  to  Dr.  Harley,  recently  published,  Dr. 
Lyle  refers  to  this  case.  According  to  the  statements 
of  her  parents,  the  child  had  passed  three  vermiform 
entozoa  from  the  bladder;  moreover,  she  also  suf- 
fered from  the  common  roundworm,  the  exhibition 
of  santonin  powders  under  Dr.  Lyle's  advice  bring- 
ing away  altogether  about  one  dozen  lumbrici.  The 
powders  were  supplemented  by  enemata  and  cold 
bathing  ;  tonics  and  diuretics  being  likewise  ordered 
from  time  to  time.  In  addition  to  the  symptoms 
above  mentioned  I  have  to  notice  that  she  was  pale 
and  anaemic,  the  skin  and  muscles  were  lax  and 
ilabby,  the  sclerotics  and  conjunctivas  almost  blood- 
less, the  tongue  white  but  clean,  the  skin  moist, 
the  pulse  irregular,  very  feeble,  and  varying  from 


BLOODWORMS.  147 

100  to  112.  It  should  also  be  added,  however,  that 
the  appetite  has  always  remained  good,  the  bowels 
being  also  regular,  and  her  sleep  undisturbed.  To 
the  naked  eye  the  urine  was  extremely  turbid  and 
very  high  coloured ;  and  after  standing  for  a  few 
hours  formed  a  thick  gelatinons  deposit  at  the  lower 
part  of  the  vessel.  On  submitting  a  little  of  the 
sediment  to  microscopic  investigation  I  at  once  dis- 
covered enormous  numbers  of  the  eggs  of  Bilharzia 
hcematobia  in  association  with  a  great  quantity  and 
variety  of  debris.  There  were  myriads  of  blood 
corpuscles,  with  a  large  quantity  of  pus  corpuscles ; 
also  numerous  scales  of  vesical  epithelium,  a  few  fat 
globules,  irregular  shreds  of  mucus,  mixed  up  with 
an  abundance  of  fine  granules  and  molecules.  In 
addition  to  these  elements  there  were  some  peculiar 
cellules,  refracting  light  very  strongly;  and,  still  more 
strange  to  say,  there  were  also  detected  at  this  first 
examination  six  oval  eggs  of  some  nematode  parasite, 
each  of  which  contained  in  its  interior  a  living 
and  actively  moving  embryo.  After  the  urine  had 
stood  for  about  twenty  hours  numerous  uric  acid 
crystals  were  found  associated  with  large  prismatic 
forms  of  the  ammonio-phosphate  of  magnesia. 

My  treatment  at  the  outset  consisted  of  tonics, 
the  cold  bathing  being  continued  as  Dr.  Lyle  had 
previously  advised.  Violent  exercise  of  all  kinds 
was  to  be  avoided,  but  she  was  to  be  constantly  out 
of  doors.  At  the  expiration  of  a  few  days  this 

L2 


143  LECTURES. 

simple  regime  began  to  be  useful,  for  the  pulse 
became  fuller  and  stronger.  On  the  3rd  of  the 
following  August,  the  haematuria  becoming  more 
marked,  I  ordered  small  doses  of  the  bicarbonate  of 
potash  in  combination  with  the  infusion  of  buchu. 
On  the  7th  1  found  the  pulse  quite  steady  and 
regular,  varying  from  100  to  104 ;  her  tongue 
showing  more  colour,  and  her  general  tone  im- 
proving. At  this  time  the  urine  was  strongly 
albuminous  (from  haemorrhage),  and  after  standing 
for  forty  hours  gave  a  specific  gravity  of  1030°. 
On  the  10th  August  she  was  placed  with  my  family 
(in  the  suburbs  of  the  metropolis),  in  order  that  her 
case  might  be  more  closely  watched.  I  was  thus 
enabled  not  only  to  judge  of  the  effects  of  treatment 
from  day  to  day,  but  also  placed,  by  thorough  and  re- 
peated examinations  of  the  excretions,  in  a  position 
to  ascertain  the  negative  and  positive  facts  of  the  para- 
sitism. On  the  evening  of  the  llth  the  pulse  had 
risen  to  118,  the  very  highly-coloured  urine  giving  a 
specific  gravity  of  1017°.  For  several  days  the  pulse 
continued  to  vary  exceedingly,  ranging  from  104  to 
126  ;  but  the  temperature  of  the  body  was  remark- 
ably uniform,  the  palm  of  the  hand  generally  giving 
94°,  the  arm-pit  95°  to  96°,  and  the  mouth  98£° 
and  99°  Fahrenheit.  I  had  some  difficulty  in 
ascertaining  the  average  of  water  passed  daily,  but 
on  the  13th  I  found  the  quantity  to  amount  to 
forty-two  ounces,  and  this,  on  standing  in  a  tall 


BLOODWORMS.  149 

glass  vessel,  settled  into  three  well-marked  layers. 
The  lowest  stratum  comprised  about  four  ounces  of 
brownish  deposit,  crowded  with  eggs  and  blood 
corpuscles ;  the  central  layer  consisted  of  twenty- 
four  ounces  of  thick  fluid  heavily  charged  with 
albumen ;  the  uppermost  layer  consisting  of  about 
fourteen  ounces  of  clear  and  healthy-looking 
urine.  The  specific  gravity  of  these  strata,  how- 
ever, varied  only  to  the  extent  of  one  degree — 
namely,  from  1011  to  1012.  On  the  14th  the 
pulse  was  quiet  and  regular,  varying  from  100 
to  108,  the  urine  registering  1017.  After  a  few 
days  the  irregularities  of  the  pulse  again  became 
more  marked,  ranging  from  118  to  120  on  the 
21st,  but  falling  to  114  on  the  26th.  In  like 
manner  corresponding  fluctuations  occurred  in 
respect  of  the  specific  gravity  of  the  urine ;  and  it 
was  at  all  times  noticeable  that  an  increase  of 
haemorrhage  always  followed  unusual  exertion  or 
excitement  of  any  kind.  Notwithstanding  these 
variations  the  general  health  steadily  improved,  so 
that  by  the  1st  of  September  the  muscles  had  re- 
gained their  firmness,  the  complexion  was  bright 
and  natural,  and  the  entire  system  had  acquired  a 
better  tone.  But  for  the  astonishing  amount  of 
natural  vigour  she  never  could  have  borne  the  per- 
sistent haematuria,  which  was  at  all  times  con- 
siderable. This,  aided  by  a  never-failing  appetite, 
enabled  her  to  consume  an  unusual  amount  of 


150  LECTURES. 

milk,  butter,  eggs,  and  especially  cream,  with  meat 
and  fish,  and  also  plenty  of  fruit,  the  latter  being 
sometimes  fresh  and  sometimes  stewed.  The  whole 
time,  or  one  month,  during  which  she  remained 
with  my  family  she  continued  to  take  the  buchu 
infusion  with  the  most  marked  advantage  ;  and  at 
the  expiration  of  that  period  she  was,  with  my 
approval,  removed  to  the  west  coast  of  England, 
where,  under  the  excellent  personal  superintendence 
of  a  relative,  she  has  continued  to  retain  her  healthy 
condition.  Nevertheless  the  hsematuria,  though 
lessened  at  times,  has  never  disappeared.  When  I 
again  saw  her  on  the  22nd  March,  1871,  her  general 
health  was  satisfactory.  She  slept  well ;  the  tongue 
was  clean  and  of  good  colour;  the  bowels  and  pulse 
were  both  regular — the  latter  numbering  104 — and 
the  appetite  hearty  as  usual.  In  the  small  quantity 
of  urine  brought  for  my  examination  I  could  find 
no  eggs  of  Bilharzia ;  but  I  soon  afterwards  ascer- 
tained that  this  afforded  me  no  true  criterion  of 
the  state  of  the  parasitism.  A  subsequent  exami- 
nation proved  them  to  exist  in  the  urine  in  great 
numbers.  Satisfied,  however,  with  the  marked 
palliative  effects  of  buchu  as  affecting  the  vesical 
mucous  membrane,  I  still  recommended  a  con- 
tinuance of  this  drug ;  but  I  deprecated  the  employ- 
ment of  injections  of  any  kind  into  the  bladder.  In 
my  last  prescriptions  I  combined  the  tincture  of 
buchu  with  the  syrup  of  bearberry  (arctostaphylos), 


BLOODWORMS.  151 

a  change  of  medicine  which  appeared  to  suit  the 
little  patient  admirably.  It  may  be  said,  indeed, 
that  but  for  the  fact  of  the  hsematuria  no  ordinary 
observer  would  suppose  that  at  the  time  I  last  saw 
her  the  child  was  otherwise  than  in  a  perfect  state 
of  health. 

This  case,  gentlemen,  is  a  most  remarkable  one  ; 
for,  apart  from  the  special  interest  attaching  to  the 
so-called  "  endemic  hsematuria "  from  Bilharzia, 
you  will  have  noticed  that  the  child  was  invaded, 
certainly  by  two,  if  not  by  three,  other  forms  of 
parasite.  She  had  been  efficiently  treated  for 
lumbrici  by  Dr.  Lyle  ;  and  it  was  alleged  that  she 
had  passed  three  small  worms  by  the  urethra.  The 
truth  of  this  latter  statement  appears  to  have  been 
borne  out  by  the  fact  that  I  discovered  numerous 
eggs  of  a  species  of  nematode  in  the  urine.  On  one 
occasion  I  found  six  ova,  and  on  another  about  fifty. 
Had  only  one  of  the  three  adult  nematodes  from 
the  urine  been  preserved  for  examination,  it  would 
have  enabled  me  to  have  solved  an  important  point 
connected  with  the  history  of  vesical  entozoa.  As 
I  it  is,  I  have  no  hesitation  in  expressing  my  belief 
that  the  nematode  ova  are  of  the  same  kind  as 
those  found  by  Dr.  Salisbury  in  a  patient  in 
America,  and  which  he  was  unfortunately  led  to 
regard  as  a  new  form  of  Trichina  (T.  cystica).  In 
respect  of  the  best  modes  of  treating  this  peculiar 
form  of  hsematuria,  I  believe  that  the  essential 


1 52  LECTURES. 

thing  is  to   support  the  system.      The   amount  of 
parasitism   and   consequent    bleeding  in    this    case 
was,  and  probably  still  is,  extraordinary.      But  for 
her  change  of  residence  and  vigorous  tonic  treatment 
away  from  the  infectious  locality,  this  child  must, 
in  my  view,  have  sooner  or  later  succumbed  to  the 
disease.     At   the  very  lowest  estimate  she  cannot 
have  expelled  less  than   10,000   eggs  of  Bilharzia 
daily;   and  on  some  occasions  I  believe  the  number 
discharged  in  twenty-four  hours  was  fully  ten  times 
that  amount.      The  santonin   remedies,  though   of 
great  service  in  securing  the  expulsion  of  the  round- 
worms,  appear  to  have  aggravated  the  hsematuria. 
The   parents,  at  all  events,  were  of  that   opinion. 
For  my  own  part,  I  should  only  foresee  great  danger 
to  the  patient  in  the  attempt  at  administering  what 
are  termed  true  parasiticides.      Be  pleased  to  bear 
in  mind  that  these  blood-flukes  are  actually  lodged 
within  the  blood-vessels;  and  you  cannot  operate 
upon  them  without  conveying  the  poisonous  remedy 
into    the    circulating    system.       Moreover,  if  you 
weaken  your  patient  in  any  way,  and  especially  by 
mere   drugging,  you   prevent   Nature   from  slowly 
working  a  natural  cure.      Even  the  employment  of 
diuretics  should    be    adopted    with    caution.      The 
only  service  they  can  render  is  mechanical,  facili- 
tating the  expulsion   of  the   parasitic   ova   by  in- 
creasing the  flow  of  the  urine.      The  administra- 
tion   of    injections    by    the     urethra    is,    in    my 


BLOODWORMS.  153 

judgment,  altogether  contra-indicated  in  the  case 
of  young  persons ;  but  in  adults,  if  the  disease 
be  far  advanced,  there  are  considerations  which 
might  induce  me  to  give  them  a  trial.  I  am 
strongly  of  opinion  that  the  efforts  voluntarily  set 
up  by  Nature  in  view  of  moderating  the  hsematuria 
— by  the  formation  of  plugs  at  the  ulcerated  points 
of  the  mucous  surface  where  the  bleeding  occurs — 
are  likely  to  be  frustrated  by  the  use  of  medicated 
injections ;  and  I  further  doubt  the  policy,  on 
general  grounds,  of  catheterizing  the  urethra  of 
young  persons  unless  there  be  the  most  cogent 
reasons  for  taking  such  a  step.  Dr.  John  Harley 
thinks  that  "  a  persevering  use  of  belladonna  and 
henbane  would  retard  the  development  of  the  para- 
site, even  if  it  did  not  result  in  its  destruction."  I 
do  not  at  all  share  in  that  opinion  ;  but  I  am  free 
to  allow  that  either  of  these  drugs  may  be  em- 
ployed with  advantage  in  advanced  stages  of  the 
hsematuria  where  a  strong  sedative  or  calmative 
action  might  be  required.  On  the  whole,  I  think 
there  are  good  and  cogent  reasons  for  recommending 
less  poisonous  agents,  and  I  therefore  particularly 
advise  the  employment  of  such  drugs  as  are 
known  to  exert  a  special  soothing  action  on  the 
mucous  membranes.  Not  only  is  buchu  a  medi- 
cine which  has  a  remarkable  power  in  allaying 
vesical  irritation  and  of  restraining  excessive 
mucous  discharges,  but,  so  far  as  my  experience 


154  LECTURES. 

goes,  no  harm  ever  results  from  its  long-con- 
tinued employment.  In  like  manner,  I  think  well 
of  the  arctostaphylos  uva  ursi,  believing  that  its 
astringent  properties  materially  assist  Nature  in 
her  endeavours  to  check  the  excessive  bleeding. 
A  small  quantity  of  hyoscyamus  may  be  advan- 
tageously combined  with  it.  Our  object  should  be, 
I  repeat,  not  to  interfere  with,  but  to  promote 
Nature's  curative  efforts.  If  I  read  the  patho- 
logical facts  correctly,  it  seems  that  the  vis  medi- 
catrix  nature  seeks  to  bring  about  this  result  by 
erecting  artificial  barriers  which  serve  to  moderate 
the  bleeding.  In  this  way,  under  ordinary  cir- 
cumstances, the  life  of  the  bearer  is  sustained  or 
held  in  the  balance  until  the  parasites  either  perish 
or  cease  to  be  capable  of  causing  active  disease. 
Depend  upon  it,  this  is  the  principle  which  should 
guide  us  in  our  treatment  of  the  Bilharzia  dis- 
order. If  the  adult  parasites  were  merely  attached 
to  the  lining  membrane  of  the  bladder,  then,  powerful 
diuretics  and  medicated  injections  would  probably 
prove  serviceable;  but  since  the  entozoa  reside  in 
the  blood  we  must  be  careful  not  to  increase  our 
patients'  troubles.  In  the  case  of  intestinal  worms, 
properly  so  called,  you  have  seen  that  the  most 
powerful  parasiticides  may  be  prescribed  without 
let  or  hindrance  ;  but  that  drug  must  be  a  truly 
subtle  worm-poison  which,  when  taken  into  the 
system,  shall  effectually  kill  these  blood- flukes 


BLOODWORMS.  155 

without  exerting  any  injurious  effects  upon  the 
parasite-bearer.  Without  any  sympathy  for  the 
system  of  infinitesimal  doses,  I  have  an  equal  dis- 
like to  over-drugging.  Patients  no  doubt  are  some- 
times unwise  enough  to  look  for  a  display  of  what 
they  are  pleased  to  call  an  active,  vigorous,  and 
masterly  mode  of  treatment ;  but  the  careful  phy- 
sician, who  by  a  prolonged  study  of  any  one  par- 
ticular class  of  disorders  has  familiarized  himself 
with  all  the  possible  bearings  of  the  case,  must  be 
guided  by  sounder  indications  than,  those  which 
commend  themselves  to  uninstructed  persons. 
Whenever  we  allow  ourselves  to  be  taught  and 
led  by  natural  laws  we  are  sure  to  effect  some 
good,  for  in  this  way  we  place  ourselves  and  our 
method  in  harmony  with  a  teaching  which  is 
essentially  Divine. 


APPENDIX. 


THE  following  list — exclusive  of  Reviews,  Leaders, 
and  other  anonymous  Articles — comprises  a  record 
of  the  Author's  Contributions  to  the  science  of 
Helminthology. 

SEPARATE  PUBLICATIONS  : — 

Entozoa;   an  Introduction,  &c.  (pp.   480),    London, 

1864. 
Supplement;    with  Index,  &c.   (pprt.  124),  London, 

1869. 
Tapeworms;  their   Sources,   &c.  (pp.  83),  London, 

1866. 
Tapeworms  and  Threadworms ;  2nd  edit.  (pp.  101), 

London,  1867. 
New  Entozootic  Malady;  Observations,  &c  (pp.  15), 

London,  1865. 
Catalogue  of  Entozoa  contained  in  the  Museum  of  the 

Eoyal  College  of  Surgeons  (pp.  24),  London,  1866. 

LANCET  : — 

On  the  Occurrence  of  Ascaris  mystax  in  the  Human 
Body ;  Jan.  1863. 

On  Spurious  Entozoa  in  Diseased  and  Healthy  Cattle  ; 
Jan.  1866. 

On  the  Discovery  of  Trichina,  in  relation  to  the  Ques- 
tion of  Priority  ;  March,  1866. 

On  Entozoa  in  Veal  and  Beef  (in  Letters  to  the  Ed.)  ; 
Feb.  and  Aug.  1865. 


158  APPENDIX. 

On  the  Curative  Treatment  of  Intestinal  Entozoa ; 
April,  1866. 

On  Entozoa  contained  in  various  Metropolitan  Mu- 
seums ;  May,  1865. 

On  the  Entozoa  of  Abyssinia  (Lecture)  ;  Dec.  1867. 

VMfiDICAL  TlMES  AND  GAZETTE  : 

Lectures  on  Practical  Helminthology  (being  the  first 

six  of  this  Series)  ;   1870. 
Entozoa  in  relation  to  Public  Health  and  the  Sewage 

Question;  Jan.  1871. 
On  Sewage,  in  relation  to  the  Dispersion  and  Vitality 

of  the  Germs  of  Entozoa ;  Feb.  1871. 

BRITISH  MEDICAL  JOURNAL  : — 

Rare  Entozoon  in  the  Hog  (in  a  letter  to  the  Ed.)  ; 
Jan.  1871. 

The  New  Hog  Parasite  (second  Communication)  ; 
Sept.  1871. 

Outbreak  of  Trichiniasis  in  Cumberland  (Announce- 
ment); April,  1871. 

DUBLIN  MEDICAL  PRESS  :— 

Note  on  Parasites  in  the  Lower  Animals ;  Feb.  1863. 

ROYAL  SOCIETY'S  PROCEEDINGS  : — 

On  the  Production  of  "  Acute  Cestode  Tuberculosis  " 
by  the  Proglottides  of  Tcenia  mediocanellata  ;  May, 
1865. 

LINNEAN  SOCIETY'S  TRANSACTIONS  : — 

Observations  on  Entozoa,  with  Notices  of  New  Species, 

&c. ;  1858. 

On  some  New  Forms  of  Entozoa;  1859. 
Further  Observations,  with  Experiments ;   1861. 


APPENDIX.  159 

LINNEAN  SOCIETY'S  PROCEEDINGS: — 

Synopsis  of  the  Distomidee,  with  Description  of  New 
Genera  and  Species ;  1859. 

Experimental  Investigations  with  Cestoid  Entozoa ; 
1865. 

On  Sclerostoma  syngamus  and  the  Disease  it  occasions 
in  Birds;  1861. 

On  the  Best  Methods  of  Displaying  Entozoa  in  Mu- 
seums ;  1864. 

Remarks  on  Coenurus  from  an  American  Squirrel; 
1864. 

On  Entozoological  Individuality;   1864. 

On  Distoma  clavatum  from  the  Sword-fish;   1867. 

On  the  Entozoa  of  the  Dog  in  relation  to  Public 
Health;  1867. 

Experiments  with  Trichina  spiralis  ;  1867. 

ZOOLOGICAL  SOCIETY'S  PROCEEDINGS  : — 

Entozoa  obtained  from  Animals  dying  at  the  Mena- 
gerie (during  four  years)  ;   1861. 
Cystic  Entozoa  from  the  Wart  and  Red  River  Hogs  ; 

1861.  .I 

Remarks  on  all  the  Human  Entozoa;   1862.  // 
On  Entozoa  collected  by  Mr.  Devis  ;   1865. 
New  Entozoon  (Acanthocheilonema)  from   the  Aard 
Wolf;  Jan.  1870. 

PATHOLOGICAL  SOCIETY'S  TRANSACTIONS  : — 

New  Species  of  Human  Tapeworm  ;   1866. 
Microscopic  Bodies  from  the  Muscles  of  Cattle  ;  1866. 
Cystic  Entozoa  from  Veal,  Beef,  and  Mutton ;   1866. 

BRITISH  ASSOCIATION  REPORTS  : — 

Report  on  Experiments  respecting  the  Development 
and  Migrations  of  Entozoa ;  1864. 


v 


160  APPENDIX. 

On  Food  as  a  Source  of  Entozoa  ;   1864. 
On  Entozoa;   (various  papers)  1865—66. 
Entozoa  of  the  Fowl  and  of  Game  Birds  ;  1867. 
On  Flukes  from  the  Indian  Elephant  ;   1868. 
On  a  Cysticercus  from  the  Human  Brain;   1870. 
On  Hsematozoa  from  the  Heart  of  a  Dog  ;  1870. 
On  the  Embryos  of  Bilharzia  heematobia;  1870. 

EDINBURGH  PHILOSOPHICAL  JOURNAL  :  — 

Description  of  a  New  Species  of  Trematode  (Fascicola 
gigantea)  ;   1855. 

&ATH  AND  WEST  OF  ENGLAND  AGRICULTURAL  JOURNAL  :  - 

On  the  Present  State  of  our  Knowledge  respecting 
Entozoa;   1865. 

JOURNAL  OF  THE  SOCIETY  OF  ARTS  :  — 

On  the  Parasites  of  our  Food-producing  Ruminants 
(Cantor  Lectures)  ;   1871. 

NATURE  :  — 

The  Discovery  of  Stephanurus  in  the  United  States 
and  in  Australia;   Oct.  1871. 

QUARTERLY  JOURNAL  OF  MICROSCOPICAL  SCIENCE  :  — 
On  Oyrodactylus  elegans  ;  1862. 
Notes  on  Tricmpidaria  and  Pentastoma  ;  1859. 

MONTHLY  MICROSCOPICAL  JOURNAL  :  — 

Report  on  Entozoa  from  Sydney;  Nov.  1871. 

POPULAR  SCIENCE  REVIEW  :  — 

Vegetables,  Fruit,  and  Water  as  Sources  of  Intestinal 
Worms;   Jan.  1865. 

INTELLECTUAL  OBSERVER:  — 
On  Flukes  ;  Feb.  1862. 


APPENDIX.  161 

The  Liver  Entozoon  of  Cattle  ;    1862. 
Parasites  from  the  Zoological  Gardens  ;   1862. 
Entozoa  of  the  Sun-fish;   1862. 
The  Whipworm  or  Trichocephalus ;   1863. 
Parasitic  Larvae ;   1863.  *T 

Recent  Discoveries  in  Entozoology  ;  1864.  /  ' 
Note  on  the  Nerve  System  of  Nematoda  ;  1864. 
Note  on  Distoma  capense ;  1864. 

CANADIAN  NATURALIST  : — 

Note  on  Tcenia  pectinata  from  the  Porcupine  ;  1862. 

ZOOLOGICAL  RECORD  : — 

Report  on  Helminth es ;    1864.    //  * 
MAUNDER'S  TREASURY  OF  NATURAL  HISTORY  : — 

Revision    of  the    Articles   Acanthocepha,  Ascarides, 
&c,  (with  numerous  additions) ;   1862. 

FIELD  : — 

Note  on  Worms  in  the  Lung  of  a  Pig ;  Jan.  1864. 
Entozoa  from  the  Heart  of  a  Seal ;  June,  1864. 

NUNN'S  WARD  MANUAL  : — 

List  of  Entozoa  interesting  to  the  Surgeon;   1865. 


INDEX. 


PAG* 

A  BDOMEN,  boils  on  the,  from  the  harvest-bug  .  .141 
„  obscure  pains  in  the,  from  tapeworm  .  77 

Abdominal  distention,  in  Case  XL 74 

Abnormalities,  their  occurrence  in  tapeworm  .  .  .76 
Abyssinian  remedy,  effects  of,  in  Case  XXVII.  .  .  51 
Action  of  the  sun's  rays  on  parasitic  ova  .  .  81 

Active  treatment,  when  to  be  resisted  ...  .64 
Acute  hysteria,  in  a  supposed  case  of  tapeworm  • .  .74 
Advice,  when  likely  to  cause  disappointment  ...  61 

,,  the  best,  sometimes  meets  with  contempt  .  .  63 
Africa,  insect  larvee,  infesting  man,  from  ....  136 

„  prevalence  of  flukes  in 143 

Age  at  which  tapeworm  is  most  common  ....  70 
Agitation,  as  a  result  of  tapeworm,  in  Case  XXXVI.  .  66 
Albuminous  urine,  in  the  Bilharzia  disease  .  .  .  148 

Albuminuria,  suspicion  of,  in  Case  LTV 96 

Amaurosis,  produced  bylumbrici 114 

America,  case  of  the  so  -called  Trichina  cystica  in  .  .161 
Anaemia,  from  the  Bilharzia  disease 146 

,,  in  connexion  with  oxyurides  ....  85 
Annoyance  from  the  escape  of  joints,  in  Case  XX.  .  .  34 
Anomalous  symptoms,  attributed  to  worms  .  .  .  115 
Anorexia,  as  a  symptom  of  threadworms  ...  .85 
Anthelmintics,  why  to  be  withheld,  as  in  Case  XXXV.  .  65 

,,  when  to  be  delayed 62 

A  nthelmintic  virtues  of  turpentine 23 

Anthomyia  canalicularis,  interesting  case  of  .         .139 

Anus,  irritation  at  the,  from  seatworms      ....       85 

,,     lumbrici  passing  by  the,  referred  to  .         .         .         .112 

Anxiety,  as  a  symptom,  in  Case  LIV 95 

„  sometimes  excessive  in  tapeworm  .  .  .11 

M  2 


164  INDEX. 

PA  61 

Aphasia,  symptoms  of,  in  Case  XLVIII.  .         .         .90 

Appetite,  loss  of,  in  trichiniasis 123 

,,       voracity  of  the,  in  young  patients         ...       85 

Areca-nut,  administered  in  Case  XLII 77 

„         powders,  effect  of,  in  Case  XXXI.     ...       59 

,,         employed  in  a  case  of  threadworm      ...       90 

„         treatment  for  tapeworm,  in  Case  XXV.    .         .       40 

„         powder,  by  whom  introduced     .         .  .25 

Armed  tapeworms  difficult  of  cure     .         .         .         .         .19 

Arctostaphylos,  recomn.  ended  in  Bilharzia         .         .         .153 

A  scar  ides,  a  common  name  for  oxyurides  .         .         .         .79 

,,         prevalence  of,  in  children 97 

,,         small  specimens  of,  in  the  urine          .         .         .151 

„         properly  so-called,  referred  to    .         .         .         .111 

„         severe  attacks  of,  in  Case  LXV.         .         .         .107 

,,         small  proportion  of  real  suffering  from       .         .       80 

A  scan*  lumbricoides,  in  frequency  of          ....     112 

„      myatcuf,  its  occurrence  in  a  child    .         .         .         .72 

M  „        rarity  of,  in  man 112 

Asthenia,  as  a  common  symptom 85 

T>  AD  symptoms  may  remain  after  a  cure         ...  14 

Bearer,  oxyurides  seldom  fatal  to  the         ...  84 

Bearer,  thirty -seven  lumbrici  in  one  .         .         .         .112 

Beef,  as  a  cause  of  tapeworm 6 

„     tapeworm,  a  perfect  specimen  procured     ...  5 

„             „          time  neceswary  for  its  growth  ...  4 

Betel  or  areca-nut,  as  a  remedy  for  tapeworm    ...  25 

Betel-nut,  given  to  dogs  for  tapeworm       .         .  40 

Bilharzia  disease,  by  whom  discovered  in  England     .         .  1 44 

Bilharzia  hcematobia,  or  human  blood-fluke        .         .         .  144 

Bilharzia,  remarkable  case  of  from  Natal   ....  145 

„         the  best  mode  of  treating  cases  of       ...  153 

Bites  of  the  harvest-bug,  in  Case  LXXIX.        .         .         .140 

Bladder,  eggs  of  nematodes  from  the           ....  151 

Bleeding  at  the  mouth,  in  Case  LXI11 105 

Blood  corpuscles  from  the  urine,  in  Bilharzia    .         .          .147 

Blood-fluke,  or  Bilharzia,  by  whom  discovered  .         .         .  144 

„             danger  of  giving  parasiticides  for    .         .         .  154 

Bothriocephalus,  from  Ireland 39 

Bots,  supposed  case  of  human 133 


INDEX.  165 

pica 

Brain,  larval  tapeworms  occur  in  the  .  .  .  8 
Brighton,  case  of  tapeworm  from  a  lad  at .  .  .  .  71 
Broad  tapeworm,  or  Botliriocephalus  ....  39 
Buchu,  its  value  in  the  Bilharzia  disease  ....  152 
Buckinghamshire,  case  of  tapeworm  from  .  .  .40 
Bursaria  vulgaris,  as  a  form  of  spurious  worm  .  .  .  133 
Butea  frondosa,  employed  in  Case  LV 98 


PAIRO,  the  Bilharzia  prevalent  at          ....     144 

California,  case  of  tapeworm  from       .         .          .         .15 

Calomel  given  in  a  case  of  tapeworm          ....       21 

Cambridge,  case  of  tapeworm  from 24 

Cape  of  Good  Hope,  the  Bilharzia  at  the    ....     144 

Carbolic  acid,  employed  in  Case  LXXX 142 

Carlsbad  mineral  waters  recommended  ....  102 
Case  of  tapeworm,  at  eighteen  months  ...  .72 
Castor-oil  by  itself  may  expel  tapeworm  .  .  .  .19 

Catalepsy,  produced  by  lumbrici 114 

Caterpillar  from  the  human  wrist       .         .         .         .          .137 

Cat,  tapeworm  of  the,  in  man 76 

Caution  necessary  in  post-mortem  determinations       .         .   m  10 
„  ,,  pronouncing  cures      .  27 

,,       why  necessary  to  exercise  great  .         .         .         .73 

Cerebral  symptoms  from  parasites 8 

Cestode  abnormalities,  their  variety  .         .         .         .78 

Charcoal,  use  of,  in  Case  LXV 107 

Chenopodium,  given  in  Case  XLVI II 90 

,,  its  value  estimated     .         .          .         .          .100 

Cheltenham,  case  of  tapeworm  at 29 

Chigoe,  effects  of  the,  in  Case  LXXX 141 

Child,  invaded  by  several  kinds  of  entozoa          .         .         .     151 
Children,  prevalence  of  ascarides  in  ....       97 

Children,  why  rarely  affected  with  tapeworm     ...       71 
Chloroform,  as  a  remedy  in  tapeworm       .         .         .         .23 

Chlorosis  attributed  to  threadworm  .         .         .       .  .         .105 

Chlorosis,  with  threadworms,  in  Case  LIII.       .  95 

Chorea  may  arise  from  tapeworm      .         .         .          .         .12 

Chorea,  symptoms  of,  in  Case  XXXV.     ....       65 

Caecum,  the  head-quarters  of  oxyurides     ....       84 

Coffee,  a  valuable  adjunct  in  treatment     ....       62 

Cold  bathing,  useful  in  the  Bilharzia  disease      .          .         .147 


166 


INDEX. 


PAQB 

Complications,  in  relation  to  question  of  diagnosis      .         .       73 

Convulsions  from  tapeworm 12 

Convulsions,  produced  by  lumbrici 114 

Convulsive  startings,  in  Case  LVIII 99 

Convulsive  twitchings,  in  Case.  LV.  ....       97 

Correct  advice  scornfully  rejected 46 

Courage  sometimes  necessary  to  a  cure      .  .         .43 

Courage  of  a  patient  rewarded,  in  Case  XVII.          .         .       32 
Cucumerine  tapeworm,  supposed  case  of  ...  75 

Curability  of  cysticerci  in  the  brain 9 

Cure,  possible  without  treatment 108 

Cypris  tristriata,  as  a  spurious  worm         .         .         .         .133 

Cysticerci,  heads  of,  present  different  characters         .         .         7 

,,       in  the  brain  may  be  diagnosed     ....         9 

„       sometimes  described  as  hydatids          .         .         .10 

"DEAFNESS,  in  a  severe  case  of  threadworms         .         .  95 

Death  from  parasites  may  be  sudden          ...  3 

Death,  how  produced  in  trichiniasis          ...  123 

Debility,  arising  from  phthisis,  in  Case  VIII.   .         .         .17 

Delay  of  treatment,  counselled  in  Case  XXXIX.      .         .  72 

Delay,  when  to  be  advised,  as  in  Case  XXXIII.       .         .  61 

Delusions  dispelled  by  advice,  in  Case  VII.       ...  17 

,,        entertained  as  to  the  presence  of  tapeworm         .  45 

„        entertained,  in  Case  III 15 

,,        entertained,  in  Case  LX 74 

„        marked,  in  Case  LXXIII.          ....  132 

Depression,  marked,  in  Case  LIV 95 

,,         of  spirits  from  tapeworm,  in  Case  XII.  .         .  26 

>»             ,»           ,,        threadworm      ....  87 

Despair,  in  an  obstinate  case  of  threadworms     ...  95 

Development  of  the  eggs  of  oxyurides         ....  82 

Diptera,  larvae  of,  passed  alive 140 

Discovery  of  trichiniasis  in  England           ....  126 

Disgust,  arising  from  tapeworm,  in  Case  XX.  ...  34 

,,       as  a  symptom,  in  Case  XXX 57 

Disorders  may  arise  from  larval  tapeworms         ...  8 
Dispensary  practice,  turpentine  successful  in                .         .24 

Distress,  extreme,  in  a  case  of  threadworms       .  98 

Diuretics,  contra  indicated  in  Bilharzia      ....  154 

Dog,  tapeworm  of  the,  in  man 76 


INDEX.  167 

PAGB 

Doubt,  necessity  of  freedom  from 15 

Doubts,  dispelled  by  treatment,  in  Case  III.     ...       16 

Diagnosis  of  Bilharzia,  in  Case  LXXXI 146 

Drastic  purgatives  in  tapeworm        .         «...       23 
Dreams,  unpleasant,  in  Case  LXX.  .         .         .         .119 

Drugs  commonly  employed  in  tapeworm  .  22 

Drugs,  if  bad,  will  cause  disappointment    ....       25 

Dublin,  case  of  tapeworm  at      ......       32 

Dyspepsia  from  tapeworm          .         .  .         .         .11 

Dysuria,  produced  by  turpentine 98 

J^DINBUKGH,  case  of  tapeworm  at     ....       16 
Effect  of  parasitism  on  refined  minds         .         .         .11 
Eggs  of  a  nematode,  from  the  bladder       .         .         .         .147 
Eggs  of  the  common  threadworm      .         .         .  .81 

Eggs  of  threadworms  said  to  convey  faeces         .         .         .     109 

Egypt,  prevalence  of  Bilharzia  in 144 

Electuaries,  employed  with  advantage       ....       88 

„  useful,  in  Case  LI 92 

Elliptic  tapeworm,  supposed  case  of  the  .  .  .  .  .76 
Emaciation  from  tapeworm,  in  Case  XII.  ...  26 

Embryos,  living,  from  the  urine 147 

Embryos  of  Oxyuris  vermicularis 81 

Endemic  haematuria,  from  Bilharzia  .         .         .151 

Enemata,  their  efficacy  in  threadworm      .          ...       97 
England,  Bilharzia  disease  noticed  in        ....     144 
„        cases  of  trichina  disease  in  .         .         .         .124 

Ennui,  symptoms  of,  attributed  to  worms         .         .         .132 

Enteritis,  death  by,  from  lumbrici 114 

Entozoa  in  the  bladder,  in  Case  LXXXI.         .         .         .146 
„        several  kinds  of,  in  one  host        .         .         .         .151 

„        spurious,  in  Case  LXXII 132 

Epileptiform  seizures  from  parasites  ....         8 

„  „       incaseLXXVII 138 

Erotomania,  produced  by  lumbrici  .  .  .  .  .114 
Erroneous  interpretation  of  symptoms,  in  Case  III.  .  14 

Ethereal  extract  of  male-fern,  as  a  remedy        ...       25 

Excrement,  persons  said  to  swallow 109 

Expulsion  of  armed  tapeworms  difficult  .  .  .  .19 
Exudation-membranes  mistaken  for  tapeworm  ...  48 
Eye,  dulness  of,  as  a  symptom,  in  Case  LIV.  .  .  95 


168  INDEX. 

PAG* 

"PISCES,  patients  said  to  swallow  each  other's         .         .     109 

„       should  always  be  examined        ....       29 

Fainting-fits,  occurrence  of,  in  threadworms      ...       89 

Faintness  not  uncommon  in  tapeworm      .         .         .         .11 

False  diagnosis,  in  Case  XXVI 45 

Fasciola  hepatica,  sometimes  found  in  man  .  .  .  143 
Fasting  before  treatment  not  necessary  .  .  25 

Females,  nervous  phenomena  in 11 

Final  causes,  in  relation  to  parasitism  ....  2 
Flesh,  loss  of,  as  a  symptom  of  tapeworm  ...  57 
Flesh-worm  disease,  discovered  in  England  .  .  .  125 
Flukes,  the  presence  in  the  human  body  .  .  .  .143 

Foreign  remedies,  value  of 101 

Friedrichshall  waters,  recommended  ....     102 

„  „      use  of,  in  Case  LXIV.     .        .         .107 

Frequent  passage  of  joints,  in  Case  XX 34 


Q. ASTRIC  juice,  its  action  on  parasitic  ova    .         .         .  82 

Genito-urinary  passages,  itching  at  the     ...  85 

Germany,  tapeworm  from,  in  Case  XXIV.       ...  38 

„         threadworms  in  a  resident  in    .         .         .         .  106 

Giddiness,  caused  by  cysticerci          .....  8 

Gigger  disease,  old  case  of  the  so-called     .         .         .         .141 

"  Globus,"  in  a  supposed  case  of  tapeworm       ...  74 

Gloucestershire,  case  of  threadworms  from         ...  87 

,,              a  second  case  of  threadworms  from  .         .  88 

M              a  third  case  of  threadworms  from      .         .  89 

Gnawing  pains,  in  a  case  of  threadworm  ....  99 

Good  advice  often  rejected,  as  in  Case  XXVI.  ...  45 

Gout,  symptoms  of,  ascribed  to  worms       .         .         .         .132 

Growth  of  tapeworm,  remarkable  in  Case  XXIX.      .         .  54 

Guests,  another  name  for  parasites 11 


TT  APH A ZARD  methods  of  treatment  condemned  .         .       42 

Harvest-bug,  interesting  case  of        ....     140 

Hsematemesis,  attributed  to  lumbrici         .         .         .         .117 

Haematozoon,  case  of  the  Bilharzia  .         .         .         .          .145 

Haematuria,  excessive,  in  Case  LXXXI 146 

Headache,  from  cysticerci 8 

Head  of  a  tapeworm  dislodged  by  a  single  dose,  in  Case  XXI.    35 


INDEX.  169 

PAGB 

Head  of  the  beef  tapeworm  described         ....         7 

,,         „     mutton  tapeworm 7 

, ,  sometimes  discharged  after  treatment  ...  56 
Health,  undermined  by  threadworms  ....  84 
Helminthology,  its  claims  as  a  distinct  science  ...  3 
Helminths,  another  name  for  worms  .  t  .  .  .  2 

„          various  kinds  in  man 79 

Hemicrania,  in  a  case  of  tapeworm   .....       68 
,,  in  a  supposed  case  of  tapeworm      ...       95 

Hemiplegia  from  tapeworm,  in  Case  XXII.  ...  35 
Hertfordshire,  case  of  tapeworm  from  .  .  .  .14 
Homburg  waters,  useful  in  threadworm  .  .  .  .102 
Homoeopathic  treatment  of  tapeworm,  in  Case  XXIII.  .  36 
Homoeopathy,  unsuccessful  in  a  case  of  threadworms  .  104 
"  Hooks  and  eyes,"  as  traps  for  lumbrici  .  .  .  114 

Host,  or  bearer,  of  ten  years'  standing  .  .  .  .52 
Hydatids,  slow  of  natural  cure  .  .  .  .  •  9 

Hyoscyamus,  useful  in  cases  of  Bilharzia  .         .         .         .154 

Hypochondriasis  after  cure,  in  Case  VI 17 

,,  tendency  to  in  threadworm        ...       88 

Hysteria,  in  connexion  with  spurious  worms      .         .         .129 

„        may  occur  in  tapeworm 12 

„        symptoms  of,  in  Case  LXXIV.  .         .         .132 

TM  AGINARY  tapeworm,  remarkable  case  of  44 

Impetiginous  ulceration,  associated  with  gigger   .         .142 

India,  seeds  of  Butea  frondosa  employed  in  .98 

,,      supposed  case  of  tapeworm  from     .         .         .         .44 

,,      tapeworm  from,  in  Case  VIII.         .         .         .          .17 

„  ,,  in  Case  IX.  ....       20 

,,  ,,  in  Case  X 21 

„  in  Case  XIII 27 

,,  „  in  Case  XV 30 

in  Case  XIX 32 

in  Case  XXXV 65 

in  Case  XXXVII.  ...       68 

Inestimable  value  of  a  correct  opinion,  in  Case  XXVI.      .       49 
Infant,  example  of  Ascaris  mystax,  in  an   .         .         .         .72 

Infusoria,  mistaken  for  worms.          .         .         .         .         .     1 33 

Injections,  why  discountenanced  in  Bilharzia     .         .         .152 
,,         .use  of  medicated,  in  Case  XLIII.   ...       86 


170  INDEX. 

Pi  OS 

Injurious  drugging  in  a  supposed  case  of  tapeworm   .         .  49 

Insect,  bites  of  an,  in  Case  LXXIX 141 

„      larvae,  beneath  the  skin,  in  Case  LXXVI.      .         .  137 

„         ,,       great  irritation  from 139 

Intestines,  lawful  inhabitants  of  the 49 

Inutility  of  homoeopathic  treatment  of  tapeworm        .         .  36 

Itching  at  the  nose  and  anus  from  tapeworm     ...  11 

JALAP  and  senna,  effects  of,  in  threadworm  .         .         .100 

„       as  a  remedy  in  tapeworm 23 

„       electuaries  of,  with  podophyllin    .  .         .92 

,,       has  been  known  to  expel  tapeworm     .         .         .19 

Jaundice,  symptoms  of,  in  Case  XXIX.  ...       55 

Joints,  a  knowledge  of  their  true  character  necessary         .         4 

„        as  the  equivalent  of  "  cucurbitini"         ...         4 

„       liable  to  vary  in  character 6 

„       their  number  in  a  full-grown  tapeworm  .         .         4 

Juugle  fever,  associated  with  tapeworm    ....       65 


IT  A  MALA,  a  remedy  for  tapeworm       ....       22 
,,          given  in  Case  XLII.  .  .         .77 

Kent,  case  of  tapeworm  from 31 

Kissingen  waters,  useful  in  threadworm    ....     102 
Knowledge  required  to  give  a  correct  opinion    .         .         .18 

Kouhso,  a  remedy  for  tapeworm 22 

„        imperfect  action  cf,  in  Case  XXXIV.  ...       64 

„       ineffectual,  in  Case  LI  1 93 

„       less  powerful  than  male- fern         .         .         .         .51 


T  ARV^E  of  anthomyia,  in  Case  LXXVII.      .         .        .138 

„       of  insects,  liable  to  attack  travellers          .         .     136 

,,       of  tapeworms  in  animal  food     ....         6 

„       of  the  common  threadworm      ....       81 

Lassitude  may  arise  from  tapeworm  .         .  10 

Leptus  autumnalis,  interesting  case  of  .         .         .140 

Leucorrhcaa,  often  associated  with  parasites      ...       85 

Life,  jeopardized  by  tapeworm,  in  Case  XIV.  ...       29 

„    not  often  endangered  by  tapeworms  .         .         .11 

Lifetime,  presence  of  worms  during  a  .         .         .87 


INDEX.  171 

PAGH 

Limbs,  movement  of,  affected  by  tapeworm       ...  75 

,,        swelling  of  the,  in  trichiniasis        ....  123 

Lime-water  injections,  uselessness  of,  in  Case  L.         .         .91 

Lincolnshire,  the  Woodhall  spa  of 102 

Liver,  action  upon  it  by  male-fern 55 

Liverpool,  interesting  case  of  tapeworm  from     ...  77 

,,          specimen  of  "  bot"  sent  from    ....  136 

,,          supposed  case  of  tapeworm  from        ...  75 

Loss  of  appetite  from  tapeworm 11 

Loss  of  consciousness  in  cerebral  cysticercus        ...  10 

Lumbrici,  comparative  rarity  of 112 

expelled,  in  Case  LXXXI 146 

„         singular  habits  of 114 

,,         suspected,  in  a  child 117 

in  Case  LXVII 116 

in  Case  LXIX 117 

,,         symptoms  they  give  rise  to         .         .         .         .113 

„         thirty-seven  in  one  patient          ....  112 

lyjAGGOTS,  precautions  in  regard  to       .        .        .        .138 

Male-fern,  a  remedy  for  tapeworm    ....       22 

Male-fern,  not  successful  in  small  doses       .         .  42 

Malformations  of  human  tapeworms   .....       76 

Manchester,  case  of  tapeworm  from  .....       34 

Mankind,  many  forms  of  entozoa  occur  in  .         .         .         .79 

Man,  liable  to  harbour  the  cucumerine  tapeworm        .         .       76 

Matter,  faecal,  eggs  not  constituent  portions  of    .         .         .109 

Mauritius,  lumbrici  abundant  in  the  .         .         .         .         .     113 

,,         the  Bilharzia  occurs  in  the  ....     144 

Measles,  or  cysticerci,  occur  in  beef   .         ....         6 

,,  „  occur  in  mutton        ....         6 

„  „  occur  in  pork  .....         6 

Measly-beef,  its  prevalence  in  the  Punjab  ...       68 

Mental  disturbance  from  parasites  ....         8 

Mercurial  ointment,  local  use  of         .....       92 

Metallic  buttons,  as  traps  for  lumbrici        .         .         .         .114 

Micturition,  pain  after,  in  Bilharzia 146 

Migration  of  parasites  during  night 85 

Mineral  waters,  recommended 102 

,,         „         their  value  in  threadworms  «         .         .107 

Mistakes  may  occur  from  a  hasty  diagnosis         ...       44 


172  INDEX. 

PAOI 

Monkey,  the  Bilharzia  discovered  in  a         .         .         .         .  1 44 

Monmouthshire,  spurious  parasites  from  ....  138 
Moral  courage  necessary  in  giving  an  opinion  .  .  .49 

Moth,  larva  of  a,  beneath  the  skin 137 

Mouth,  Jurobrici  passing  by  the,  referred  to         .         .         .  112 

,,      parasites'  eggs  conveyed  to  the  84 

Mutton,  as  a  cause  of  tapeworm 6 

TRAILS,  eggs  of  parasites  lodged  under  the       ...       83 

Nasal  irritation,  in  a  case  of  tapeworm       .         .         .77 

Natal,  prevalence  of  the  Bilharzia  at          .         .         .         .144 

Necessity  of  a  correct  diagnosis 44 

Negative  opinions  often  displeasing  .         .         .         .         .46 
,,       result,  why  obtained,  as  in  Case  XXXII.    .         .       60 

Nervous  irritability  from  tapeworm 11 

,,        symptoms,  anomalous,  in  Case  LXVI.          .         .115 
,,  „          may  remain  after  cure         .         .         .12 

„        system,  state  of,  in  Case  XLI 75 

Neurotonics,  effect  of,  in  Case  XXXVI 67 

Newcastle,  case  of  tapeworm  from 36 

Newport,  case  of  anthomyia  from 138 

New  remedies,  disappointment  from 101 

New  York,  tapeworm  from,  in  Case  XXX.  ...  57 
Night,  exacerbation  of  symptoms  during  ....  84 

Noises  in  the  head  from  tapeworm 11 

,,  ,,         in  a  case  of  tapeworm  ....       68 

Norfolk,  case  of  ascarides  from 104 

,,        case  of  tapeworm  from          .                  .         .         .60 
Norway,  tapeworm  contracted  in 53 

/"OBSCURE  pains  may  arise  from  tapeworm     .         .         .11 

Obstinate  case  of  tapeworm  successfully  treated          .       36 

Obstinate  cases,  their  occurrence 50 

„  tapeworm,  in  Case  XXIX 52 

Occurrence  of  cases  of  trichina  in  England  .  .  .122 
CEstrus  humanuSj  supposed  case  of  .  .  .  .133 

Oil  of  male-fern  in  tapeworm  ......  22 

Oil  of  turpentine  in  tapeworm 23 

Opinion,  importance  of  an,  in  Case  XXXVI.  ...  66 

,,  principle  to  be  observed  in  forming  an  62 

Opisthotonic  symptoms,  in  Case  II 12 


INDEX.  173 

PAGE 

Organic  disease,  simulation  of    .         .         .         .         .         .85 

Oxide  of  silver,  as  a  remedy  in  tapeworm   ....  23 

Oxford,  case  of  tapeworm  from  ......  61 

Oxfordshire,  case  of  spurious  worms  from  .         .         .         .131 

Oxyurides,  expelled  in  a  case  of  tapeworm  ....  69 

,,          symptoms  of,  after  cure 74 

,,          the  best  way  to  rear  them          .         .         ...  82 

,,          the  proper  name  for  ascarides  ....  79 

Oxyuris,  universal  distribution  of  the         ....  80 

Oxyuris  vermicularis,  eggs  of  the        ...'..  81 

Ova  of  Bilharzia,  numbers  passed  daily      ....  152 

Ova  of  nematodes,  fifty- six,  from  the  urine        .         .         .  151 

Over-drugging,  exemplified  in  Case  LXXIII.    ...        *  132 

pAINFUL  case  of  mal-treatment 44 

Panna,  a  remedy  for  tapeworm 22 

Paralysis,  symptoms  of,  in  Case  XLVIII.  ...  90 
Paralytic  symptoms  from  tapeworm,  in  Case  XXII.  .  35 

Parasitic  disease  may  be  overlooked 18 

Parasiticide,  male- fern  as  such,  in  Case  XXX.   ...       57 

Parasiticides,  danger  of,  in  Bilharzia 152 

Parasite-bearer,  at  the  age  of  fourteen  months    ...       73 

Parasites,  eggs  of,  action  of  the  sun's  rays  on     .         .         .81 

,,         enormous  quantities  expelled       ....     100 

„        liable  to  aggravate  other  disorders      .         .         .     106 

,,       migration  of  during  night  .         .         .         .85 

„       spurious,  in  Case  LXXVIII 138 

„       suspected,  in  Case  LXVIII 116 

Parasitism,  spurious  example  of,  in  Case  XL.  ...       73 

„          remarkable  case  of 151 

Paris,  tar -water  treatment  of  tapeworm  at  .  .  .12 
Patients  sometimes  wrongly  treated  ....  44 

Patient,  thirty-seven  lumbrici  in  one         .         .         .         .112 

Personal  cleanliness  essential 108 

Peru,  case  of  tapeworm  with  trichocephalus  from  .  .  30 
Petersburg,  case  of  tapeworm  treated  at  St.  .  .  .  53 
Picro-nitrate  of  potash,  as  a  remedy  ....  124 

Podophyllin,  its  value  estimated        .         .         .         .         .100 

„  useful,  in  Case  LI 92 

Pomegranate-root  bark,  a  remedy  for  tapeworm  .  .  22 
Poonah,  beef-tapeworm  contracted  at  ....  32 


174  INDEX. 

MM 

Population,  prevalence  of  threadworms  in  the    ...       80 

Pork,  as  a  cause  of  tapeworm 6 

„     eaten  in  a  perfectly  raw  state  ....       77 

Pork  tapeworm,  case  of,  from  India          ....       20 
„  twenty-four  feet  of  ....       78 

Portal  blood,  Bilharzia  found  in  the  .         .         .         .144 

Possibility  of  a  cure  in  measles  of  the  brain  ...  9 
Potatoes,  portions  of,  mistaken  for  "bots"  .  .  .134 

Powder  of  male-fern,  as  a  remedy 26 

Pricking  sensations,  as  symptoms,  in  Case  XXVII.  .       51 

Principles  of  treatment  to  be  observed        ....     165 

Proglottides,  liable  to  malformation 76 

„  or  joints,  in  » bird's  tapeworm       ...       37 

„  referred  to,  in  Case  XXVIII.       .         .         .       52 

Proglottid,  remarkable  Hunterian  specimen  of  .  .  .78 
Prolonged  search  for  the  head  of  a  tapeworm  sometimes 

necessary 36 

Proper  advice  frequently  eschewed 11 

Prostration,  in  a  severe  case  of  threadworms  ...  95 
Pruritus,  as  a  symptom  of  parasitism  ....  85 
Pseudhelminth,  remarkable  example  of  .  .  .48 

Pseudhelminths,  what  they  may  be 129 

Pseudo-tapeworm,  remarkable  case  of  .         .         .46 

Puberty,  local  disorders  from  parasites  during  ...  85 
Pullna  mineral  waters,  recommended  .  .  .  .102 
Pulse,  state  of,  in  a  case  of  Bilharzia  ....  149 
Pumpkin-seeds,  a  remedy  for  tapeworm  ....  22 
Punjab,  case  of  tapeworm  from  the  .  .  .  .  .17 
„  tapeworm  contracted  in  the  ....  68 
Purgatives,  not  well  borne,  in  Case  XLV.  ...  88 

TJAISIN,  undigested,  mistaken  for  a  "  bot "  .         .     134 

llectum,  eggs  of  oxyurides  must  pass  by  the      .         .109 

,,        the  supposed  habitat  of  threadworms  .       84 

Re-infection,  precautions  against 108 

Remarkable  instance  of  mal-diagnosis        .         .  •  .45 

Remedial  measures  to  enforce  an  opinion,  in  Case  IV.  .  16 
Residence  at  Homburg,  use  of  resorting  to  .  .  .105 
Restlessness  may  arise  from  tapeworm  .  .  .  .11 
Rheumatism,  symptoms  of,  ascribed  to  worms  .  .  .132 
Rheumatoid  pains,  in  cases  of  trichina  ....  123 


INDEX.  175 


Rochester,  tapeworm  from,  in  Case  XXII.         .         . 

Rolls  of  exudation  may  simulate  tapeworm  »« 

Roundworms,  comparative  rarity  of  .         .         ,         .         .     112 


PAGE 
35 
48 


O  ALINES,  effective,  in  cases  of  threadworm           .         .  97 
Salts,  prepared  from  mineral  waters,  useful         .         .103 

Salt,  utility  of,  in  Case  XLVIII 89 

Santonin,  its  specific  action  in  lumbrici     ....  121 

,,        its  value  estimated 100 

,,        prejudicial  action  of,  in  Case  XLVII.        .         .  89 

,,        useful,  in  Case  XLIX 90 

Saxe-Meiningen  waters,  value  of  the         ....  107 
Scammony,  as  a  remedy  in  tapeworm        ...         .23 

Scarborough,  case  of  ascarides  from          ....  86 

Seat-worm,  in  association  with  tapeworm           ...  68 

,,          not  confined  to  young  persons         ...  80 

Seeds  of  Butea  frondosa,  referred  to          ....  101 

Segments,  another  name  for  joints 4 

Self-deception,  remarkable  case  of    .         .         »         .         .  133 

Senna  and  jalap,  effects  of,  in  threadworm         .         .         .100 

Sexual  irritation,  an  occasional  symptom           ...  85 

„      papillse,  sometimes  double     .....  76 

Sight  affected  by  tapeworms 11 

Single  dose  of  male-fern  successful,  in  Case  XXI.       .         .  35 

Six  years  of  unnecessary  treatment,  in  Case  XXVI.           .  44 

Sleep,  disturbance  of,  in  Case  LVIII 99 

,,       ingestion  of  parasitic  ova  during      ....  83 

Sleeplessness,  a  symptom  of  tapeworm       ....  61 

Small  doses  of  male-fern  rarely  successful          ...  40 

Spectral  illusions  from  tapeworm,  in  Case  XXII.      .         .  36 

Spigelia,  administered,  in  Case  LIII 95 

Spurious  parasitism,  in  Case  LXXV 134 

„        worm,  in  Case  LXXI. 129 

Staffordshire,  case  of  tapeworm  from          ....  58 

Stool- examinations,  essential  to  perfect  success          .         .  48 

Stratford-on-Avon,  case  of  ascarides  from           ...  89 
Strawberry-seeds  mistaken  for  worms         .         .         .         .131 

Strobile,  refers  to  the  body  of  the  tapeworm      ...  38 

Strychnia,  employed  in  Case  LXIII 105 

Suicidal  tendency  from  tapeworm,  in  Case  XII.        .          .  26 

Sulphuric  ether,  known  to  effect  a  cure    ....  100 


176  INDEX. 

Pi  SB 

Sulphuric  ether,  useful  in  Case  L 91 

Sulphur,  use  of,  in  Case  LXV 107 

Superiority  of  male-fern  as  a  worm-poison          ...  41 

Supplementary  or  fifth  sucker  of  the  beef  tapeworm            .  35 

Suspected  tapeworm,  cases  of,  not  uncommon            .         .  66 

Sussex,  case  of  persistent  threadworms  from      ...  88 
Swallowing  faecal  matter,  how  said  to  be  effected       .         .109 

Swelling  of  the  limbs,  in  trichiniasia           ....  123 
Sympathetic  phenomena,  induction  of                .         .         .85 

Symptoms  from  cysticerci  sometimes  overlooked        .         .  8 

,,         of  the  trichina  disease 123 

,,         produced  by  lumbrici 113 

„         produced  by  tapeworms 10 


solium.  malformed  example  of  .         .         .         .78 
Tansy  enemata,  employed  in  Case  XLII.          .         .104 

Tapeworm,  absence  of ,  in  Case  II 12 

,,  alleged  to  be  thirty  feet  in  length  .         .         .61 

„  associated  with  jungle  fever     ....       65 

,,  contracted  at  fourteen  months         ...       73 

,,  dislodged  by  areca-nut 77 

,,  from  beef,  nineteen  feet  long  .         .         .         .57 

„          in  a  boy  of  six,  in  Case  XXXVIII.         .         .       71 
, ,  in  a  child  four  years  old  .         .         .         .21 

,,  not  unfrequently  overlooked  ....       66 

,,  of  nine  years'  duration,  in  Case  XVII.  .         .       31 

„  of  the  dog  and  cat  in  man       ....       75 

„  rarely  or  never  incurable          .         .         .         .43 

,,  remarkable  Hunterian  specimen  of  78 

„          seventeen  feet  of,  in  Case  XXXI.    .         .         .58 
,,  seventy  feet  of,  in  one  case    .         .         .         .77 

„  threadworms  following,  case  of  .         .92 

„  treated  by  areca-nut,  in  Case  XXV.        .         .       40 

„  why  most  common  at  middle  age     ...       71 

Tapeworms,  are  multiple  creatures   .  ...         3 

,,  at  what  age  most  frequent     .  .         .70 

,,  their  destructive  characters    ....         7 

,,  two  present,  in  Case  XIII 27 

Tar-water,  injudiciously  given,  in  Case  II.        ..         .       12 

Teeth,  grinding  of,  during  sleep 85 

Teleology,  in  relation  to  parasitism 2 


INDEX.  177 

PAGB 

Temperature,  in  a  case  of  Bilharzia 148 

Territory,  lawful  inhabitants  of  the  intestinal    .  .      .         .109 

Threadworms,  an  extreme  case  of 91 

,,  apparently  proved  fatal      ....       95 

„  distressing  case  of  .         .         .         .98 

„  harboured  for  fifty  years     .         .         .         .103 

„  harboured  for  sixteen  years,  in  Case  XLIV.       87 

,,  harboured  throughout  life,  in  Case  XLV.  .       87 

, ,  hundreds  passed  by  a  patient      .         .         .99 

,,  severe  symptoms  of,  in  Case  XL VIII.         .       89 

,.  their  abundance  in  England        ...       80 

,,  value  of  enemata  in  cases  of  .         .97 

„  value  of  salines  in  cases  of          ...       97 

„  with  tapeworm,  in  Case  XXXVII.     .         .       68 

Tin,  as  a  remedy  in  tapeworm          .  .  23 

Tingling  sensations,  from  tapeworm  .....       75 

Tongue,  foulness  of,  as  a  symptom   .....       95 

Tonic  treatment,  why  adopted,  in  Case  XLI.    ...       75 

Torpor  precedes  death  in  cerebral  cysticercus     ...       10 

Transformations  of  the  embryos  of  oxyuris          ...       84 

Treatment  for  worms,  refused  in  Case  XXXVI.         .         .67 

„          necessary  to  enforce  an  opinion,  in  Case  VIII.        17 

,,          of  cases  of  Bilharzia  hcematobia        .         .         ,152 

,,          of  threadworms,  danger  of  delay  in  the     .         .       95 

,,          when  advisable  to  delay  it  .         .         .59 

Trembling  of  the  limbs,  in  Case  LIV.        ....       95 

Trichina  cystica,  the  so-called,  case  of        .         .         .         .151 

Trichina  spiralis,  some  account  of 122 

Trichiniasis,  by  whom  discovered  in  England    .         .         .     126 
Trichocephalus,  common  in  ruminants      ....       67 

expelled,  in  Case  XVI 31 

Turpentine,  a  remedy  for  tapeworm          .         .  .22 

,,          ineffectual,  in  Case  LII.        ....       93 
,,          successful  treatment  by,  in  Case  XI.      .         .       24 

T INARMED  tapeworms  comparatively  abundant  .  .  19 
Uncleanliness,  remarks  upon  .....  83 
Unfortunate  results  from  hasty  diagnosis  ....  44 
United  States,  case  of  tapeworm  from  the  .  .  .57 
Urine,  eggs  of  the  so-called  Trichina  cystica  in  .  .151 

Uterine  symptoms  aggravated  by  parasites        .         .         .     106 

N 


178  INDEX. 

PAGB 

"U"ALUE  of  areca-nut  in  tapeworm  .    -    .         .         .25 

„       of  good  drugs  shown,  in  Case  XVIII.       .         .       32 

Variety  of  remedies,  erroneously  given,  in  Case  XXVI.     .       44 

Vigorous  treatment  sometimes  necessary,  as  in  Case  XVII.      31 

Vermifuge  properties  of  betel-nut 40 

Vermifuges  sometimes  given  indiscriminately  ...  18 
Vesical  entozoa,  associated  with  Bilharzia  .  .  .  146 
Vision,  loss  of,  saved  by  treatment,  in  Case  XIV.  .  .  29 
Vis  medicatrix  natures,  its  power  in  Bilharzia  .  .  .154 
Voracity,  as  a  symptom,  in  Case  XL 74 

WATERS  of  Friedrichshall,  in  Case  LX.       .        .         .103 

„          Homburg  useful,  in  Case  LXII.        .         .     104 

„          Pullna,  their  activity  referred  to        .         .106 

Water  vascular  system  of  the  larvae  of  Bilharzia         .         .145 

Weariness  may  arise  from  tapeworm          .         .         .         .10 

West  Indies,  case  of  gigger  from  the         ....     141 

Whipworm,  expelled  by  male-fern 31 

„  rare  in  this  country  in  man    ....       67 

Woodball  mineral  waters,  recommended  .  .  .  .102 
Wool,  fibres  of,  mistaken  for  worms  .  .  .  .130 

Worksop,  case  of  supposed  "bots"  from    .         .         .         .133 

Worms,  suspected,  in  Case  LXX. 118 

"Worm  that  dieth  not,"  supposed  case  of  the  .         .         .     130 


VOOLOGICAL  GARDENS,  tapeworm  in  a  bird  from          37 


THE  END. 


LONDON: 

SAVILL,  EDWAKDS  AND  CO.,  PRINTEBS,  CHANDOS  STREET, 
COVENT  GABDEN. 


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